Drift detection of a haptic input device in a robotic surgical system

ABSTRACT

An input device for controlling operation of a robotic arm may include a grasper that includes a first finger pad. The first finger pad may include a first set of two or more electrodes for determining user presence at the first finger pad. The input device may also include a processor for modifying operation of the robotic arm in response to information from the input device in accordance with a determination of the user presence at the first finger pad. A method for operating a surgical tool via the input device is also disclosed herein.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application claims the benefit of U.S. Provisional Application No.63/270,561, filed on Oct. 21, 2021, entitled “Drift Detection of aHaptic Input Device in a Robotic Surgical System,” which is herebyincorporated by reference in its entirety.

This application is related to U.S. Pat. Application No._________________________ (Attorney Docket No. 125523-5491), filed onOct. 20, 2022, entitled “Reduction of false Positive Haptic Inputs in aRobotic Surgical System,” which is hereby incorporated by reference inits entirety.

TECHNICAL FIELD

The systems and methods disclosed herein are directed to input devices,and more particularly to input devices for robotic surgical systems.

BACKGROUND

A robotically enabled medical system is capable of performing a varietyof medical procedures, including both minimally invasive procedures,such as laparoscopy, and non-invasive procedures, such as endoscopy(e.g., bronchoscopy, ureteroscopy, gastroscopy, etc.).

Such robotic medical systems may include robotic arms configured tocontrol the movement of medical tool(s) during a given medicalprocedure. The robotic medical system may also include an input deviceused to control the positioning and/or actuation of the medical tool(s)during the medical procedure.

SUMMARY

The systems, methods and devices of this disclosure each have severalinnovative aspects, no single one of which is solely responsible for thedesirable attributes disclosed herein.

In one aspect, an input device for controlling a robotic surgical toolis provided. The input device can include a first pair of opposing linksand a second pair of opposing links. The first pair of opposing linksand the second pair of opposing links can be arranged radiallysymmetrically. The input device can be configured to control operationof the robotic surgical tool.

In some configurations, the first pair of opposing links is longer thanthe second pair of opposing links. The first pair of opposing links canbe of equal length as the second pair of opposing links. Each of thefirst pair of opposing links can include a finger pad. Each of thesecond pair of opposing links can include a clutch button. The clutchbutton can be a push button. The clutch button can include a protrudingledge. The input device can include at least one clutch button. The atleast one clutch button, when actuated, can be configured to decouplethe input device from controlling operation of the robotic surgicaltool. Each of the first pair of opposing links and each of the secondpair of opposing links can be coupled to a central longitudinal member.The proximal ends of each of the first pair of opposing links and eachof the second pair of opposing links can be configured to radially moverelative to the central longitudinal member. Each of the first pair ofopposing links can be configured to move together. Each of the secondpair of opposing links can be configured to move together. The firstpair of opposing links and the second pair of opposing can be areconfigured to move together. Each of the first pair of opposing linkscan be configured to move together, such that proximal ends of the firstpair of opposing links are positioned equally distant from the centrallongitudinal member. The first pair of opposing links can be constrainedto move together. The second pair of opposing links can be constrainedto move together. The central longitudinal member can include a halleffect sensor.

In another aspect, an input device for controlling a robotic surgicaltool can be provided. The input device can include a multi-link graspercomprising three or more links coupled to a central longitudinal member.The three or more links can be spaced less than 180 degrees from oneanother about the central longitudinal member. The multi-link graspercan be configured for controlling operation of the robotic surgicaltool. The three or more links can be equally spaced from each other.Each of the three or more links can be configured to move from an openposition where proximal ends of each of the three or more links arepositioned radially away from the central longitudinal member to aclosed position where the proximal ends of each of the three or morelinks are positioned radially close to the central longitudinal member.Each of the three or more links can be biased in the open position.

In yet another aspect, an input device for controlling a surgical toolcan be provided. The input device can include a multi-link graspercomprising two or more links about a central longitudinal member forcontrolling operation of the surgical tool.

In some configurations, the at least one of the two or more links caninclude a finger input. The finger input can be capable of operating ina first mode and in a second mode. In the first mode, the finger inputcan operate as a finger clutch and in the second mode, the finger clutchoperates as a selecting tool. The finger input can include a push input.The finger input can include a rotary input. The central longitudinalmember can include a sensor for detecting a mode of the finger input.The sensor can be coupled to the central longitudinal member. Each ofthe two or more links can include a curved face at a proximal end. Thecurved face can wrap around the central longitudinal member. The inputdevice can include a rack gear. The rack gear can include gear teethconfigured to mate with each of the two or more links. Each of the twoor more links can be configured to rotate relative to the rack gear,wherein each of the two or more links are configured to engage with therack gear such that rotation of one of the two or more links causesrotation of remaining links of the two or more links. Each of the two ormore links can include bevel gear teeth configured to connect motion ofeach of the two or more links to the remainder of the two or more links.

In yet another aspect, a physician console can be provided. Thephysician console can include an input device including a first grasperand a second grasper. The input device can be configured to control asurgical tool. At least one of the first and second grasper can includea four-link radially symmetrical grasper for controlling operation ofthe surgical tool.

In accordance with some embodiments, an input device for controllingoperation of a robotic arm is provided. The input device can include afirst finger pad that includes a first set of two or more electrodes fordetermining a user presence at the first finger pad. The input devicecan also include a processor for modifying operation of the robotic armin response to information from the input device in accordance with adetermination of the user presence at the first finger pad.

In accordance with some embodiments, a method for operating a surgicaltool via an input device is performed by one or more processorsexecuting instructions store in memory. The method includes, whileoperating a robotic arm in response to information from an input device:(i) receiving first information from a first set of two or moreelectrodes, (ii) determining a user presence at a first finger pad basedon the first information, and (iii) modifying operation of the roboticarm in response to the information from the input device in accordancewith a determination of the user presence at the first finger pad. Insome embodiments, modifying teleoperation of the robotic arm in responseto the information from the input device may include any of: ceasingmovement of the robotic arm in response to the information from theinput device, reducing a velocity of the robotic arm in response to theinformation from the input device, or reducing motion scaling betweenthe input device and the robotic arm.

In accordance with some embodiments, a medical system includes an inputdevice for controlling operation of a robotic arm. The input deviceincludes a grasper, the grasper includes a first finger pad, and thefirst finger pad includes two or more electrodes. The input device alsoincludes an integrated circuit for measuring a mutual capacitancebetween the two or more electrodes of the first set of two or moreelectrodes for determining a user presence at the first finger pad.

In accordance with some embodiments, a medical system includes an inputdevice for controlling a medical instrument. The input device includes agrasper for receiving user input and a sensor coupled to the grasper forgenerating sensor information related to a user presence at the grasper.The input device includes a processor and memory storing instructionsfor execution by the processor. The stored instructions includeinstructions for receiving secondary information associated with thegrasper and determining a user presence at the grasper based on thesensor information and the secondary information.

In accordance with some embodiments, an input device for controllingoperation of a robotic arm includes a grasper and a sensor coupled tothe grasper for generating sensor information related to a user presenceat the grasper. The input device also includes a processor and memorystoring instructions for execution by the processor. The storedinstructions include instructions for receiving secondary informationfrom the input device, determining whether a user is in control of theinput device based on the sensor information and the secondaryinformation, and in accordance with a determination that the user is notin control of the input device, transitioning the medical system into asafe mode.

In accordance with some embodiments, a medical system includes an inputdevice for controlling operation of a robotic arm. The input deviceincludes a grasper and a sensor coupled to the grasper for generatingsensor information related to a user presence at the grasper. Themedical system also includes a processor and memory storing instructionsfor execution by the processor. The stored instructions includeinstructions for receiving secondary information from the input device,determining whether a user is in control of the input device based onthe sensor information and the secondary information, and in accordancewith a determination that the user is not in control of the inputdevice, transitioning the medical system into a safe mode.

In accordance with some embodiments, a method for operating a medicalsystem that includes an input device for controlling a medicalinstrument is performed by one or more processors executing instructionsstored in memory. The method includes receiving, from a sensor coupledto a grasper of the input device, sensor information related to a userpresence at the grasper. The method also includes receiving secondaryinformation associated with the grasper and determining user control atthe grasper based on the sensor information and the secondaryinformation.

Note that the various embodiments described above can be combined withany other embodiments described herein. The features and advantagesdescribed in the specification are not all inclusive and in particular,many additional features and advantages will be apparent to one ofordinary skill in the art in view of the drawings, specification, andclaims. Moreover, it should be noted that the language used in thespecification has been principally selected for readability andinstructional purposes and may not have been selected to delineate orcircumscribe the inventive subject matter

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosed aspects will hereinafter be described in conjunction withthe appended drawings, provided to illustrate and not to limit thedisclosed aspects, wherein like designations denote like elements.

FIG. 1 illustrates an embodiment of a cart-based robotic system arrangedfor diagnostic and/or therapeutic bronchoscopy.

FIG. 2 depicts further aspects of the robotic system of FIG. 1 .

FIG. 3 illustrates an embodiment of the robotic system of FIG. 1arranged for ureteroscopy.

FIG. 4 illustrates an embodiment of the robotic system of FIG. 1arranged for a vascular procedure.

FIG. 5 illustrates an embodiment of a table-based robotic systemarranged for a broiiciioscopic procedure.

FIG. 6 provides an alternative view of the robotic system of FIG. 5 .

FIG. 7 illustrates an example system configured to stow robotic arm(s).

FIG. 8 illustrates an embodiment of a table-based robotic systemconfigured for a ureteroscopic procedure.

FIG. 9 illustrates an embodiment of a table-based robotic systemconfigured for a laparoscopic procedure.

FIG. 10 illustrates an embodiment of the table-based robotic system ofFIGS. 5-9 with pitch or tilt adjustment.

FIG. 11 provides a detailed illustration of the interface between thetable and the column of the table-based robotic system of FIGS. 5-10 .

FIG. 12 illustrates an alternative embodiment of a table-based roboticsystem.

FIG. 13 illustrates an end view of the table-based robotic system ofFIG. 12 .

FIG. 14 illustrates an end view of a table-based robotic system withrobotic arms attached thereto.

FIG. 15 illustrates an exemplary instrument driver.

FIG. 16 illustrates an exemplary medical instrument with a pairedinstrument driver.

FIG. 17 illustrates an alternative design for an instrument driver andinstrument where the axes of the drive units are parallel to the axis ofthe elongated shaft of the instrument.

FIG. 18 illustrates an instrument having an instrument-based insertionarchitecture.

FIG. 19 illustrates an exemplary controller.

FIG. 20 depicts a block diagram illustrating a localization system thatestimates a location of one or more elements of the robotic systems ofFIGS. 1-10 , such as the location of the instrument of FIGS. 16-18 , inaccordance to an example embodiment.

FIG. 21A illustrates an input device in an open position in accordancewith some embodiments.

FIG. 21B illustrates the input device of FIG. 21A in a closed positionin accordance with some embodiments.

FIG. 22 illustrates the input device of FIGS. 21A-21B in an explodedview in accordance with some embodiments.

FIG. 23 illustrates the input device of FIGS. 21A-21B and 22 without aplurality of links in accordance with some embodiments.

FIG. 24A illustrates the input device of FIGS. 21A-21B and 22-23 withouta second pair of links in an open position in accordance with someembodiments.

FIG. 24B illustrates the input device of FIG. 24A in a closed positionin accordance with some embodiments.

FIG. 25A illustrates a top view of a first link with a finger pad inaccordance with some embodiments.

FIG. 25B illustrates a bottom view of the first link of FIG. 25A inaccordance with some embodiments.

FIG. 26 illustrates yet another example of a third link with secondaryinput in accordance with some embodiments.

FIG. 27 illustrates another example of an input device in accordancewith some embodiments.

FIG. 28 illustrates a cross sectional view of another example of aninput device in accordance with some embodiments.

FIGS. 29A and 29B illustrate a sensor at the input device of FIG. 21Afor sensing a user presence in accordance with some embodiments.

FIG. 30A illustrates measuring a self-capacitance of an electrode of thesensor shown in FIG. 29B in accordance with some embodiments.

FIGS. 30B and 30C illustrate measuring capacitance between theelectrodes of the sensor shown in FIG. 29B in accordance with someembodiments.

FIG. 30D illustrates cross-talk between the electrode shown in FIG. 30Awith other components of the input device of FIG. 21A in accordance withsome embodiments.

FIG. 30E illustrates a shield that reduces cross-talk between theelectrode shown in FIG. 30A and other components of the input device ofFIG. 21A in accordance with some embodiments.

FIG. 31 illustrates an example of the sensor shown in FIGS. 29A and 29Bthat includes an electrode layer and a shield layer in accordance withsome embodiments.

FIGS. 32A and 32B illustrate examples of electrode configurations forthe sensor shown in FIG. 29 in accordance with some embodiments.

FIG. 33 illustrates an example measurement for sensing a user presenceusing the sensor shown in FIGS. 29A and 29B in accordance with someembodiments.

FIGS. 34A and 34B illustrate coupling of the sensor shown in FIGS. 29Aand 29B to an integrated circuit for sensing a user presence inaccordance with some embodiments.

FIGS. 35A and 35B illustrate examples of light curtain configurationsgenerated by optical sensors located at the input device of FIG. 21A forsensing a user presence in accordance with some embodiments.

FIGS. 36A and 36B illustrate examples of finger loops for use inconjunction with time-of-flight sensors at the input device of FIG. 21Ain accordance with some embodiments.

FIG. 37 illustrates robotic joints of a gimbal supporting the inputdevice of FIG. 21A in accordance with some embodiments.

FIG. 38A is a state diagram illustrating states of a medical system inaccordance with some embodiments.

FIG. 38B illustrates transitions among different states of a medicalsystem in accordance with some embodiments.

FIGS. 39A and 39B are a flowchart illustrating a method for operating asurgical tool via the input device of FIG. 21 in accordance with someembodiments.

FIG. 40 is a flowchart illustrating a method of operating a medicalsystem for controlling a medical instrument using the input device ofFIG. 21 in accordance with some embodiments.

FIG. 41 is a flowchart illustrating a method of operating a medicalsystem that includes the input device of FIG. 21 in accordance with someembodiments.

FIG. 42 is a schematic diagram illustrating electronic components of amedical system that includes the input device of FIG. 21A in accordancewith some embodiments.

DETAILED DESCRIPTION 1. Overview

Aspects of the present disclosure may be integrated into arobotically-enabled medical system capable of performing a variety ofmedical procedures, including both minimally invasive, such aslaparoscopy, and non-invasive, such as endoscopy, procedures. Amongendoscopic procedures, the system may be capable of performingbronchoscopy, ureteroscopy, gastroscopy, etc.

In addition to performing the breadth of procedures, the system mayprovide additional benefits, such as enhanced imaging and guidance toassist the physician. Additionally, the system may provide the physicianwith the ability to perform the procedure from an ergonomic positionwithout the need for awkward arm motions and positions. Still further,the system may provide the physician with the ability to perform theprocedure with improved case of use such that one or more of theinstruments of the system can be controlled by a single user.

Various embodiments will be described below in conjunction with thedrawings for purposes of illustration. It should be appreciated thatmany other implementations of the disclosed concepts are possible, andvarious advantages can be achieved with the disclosed implementations.Headings are included herein for reference and to aid in locatingvarious sections. These headings are not intended to limit the scope ofthe concepts described with respect thereto. Such concepts may haveapplicability throughout the entire specification.

A. Robotic System - Cart

The robotically-enabled medical system may be configured in a variety ofways depending on the particular procedure. FIG. 1 illustrates anembodiment of a cart-based robotically-enabled system 10 arranged for adiagnostic and/or therapeutic bronchoscopy. During a bronchoscopy, thesystem 10 may comprise a cart 11 having one or more robotic arms 12 todeliver a medical instrument, such as a steerable endoscope 13, whichmay be a procedure-specific bronchoscope for bronchoscopy, to a naturalorifice access point (i.e., the mouth of the patient positioned on atable in the present example) to deliver diagnostic and/or therapeutictools. As shown, the cart 11 may be positioned proximate to thepatient’s upper torso in order to provide access to the access point.Similarly, the robotic arms 12 may be actuated to position thebronchoscope relative to the access point. The arrangement in FIG. 1 mayalso be utilized when performing a gastro-intestinal (GI) procedure witha gastroscope, a specialized endoscope for GI procedures. FIG. 2 depictsan example embodiment of the cart in greater detail.

With continued reference to FIG. 1 , once the cart 11 is properlypositioned, the robotic arms 12 may insert the steerable endoscope 13into the patient robotically, manually, or a combination thereof. Asshown, the steerable endoscope 13 may comprise at least two telescopingparts, such as an inner leader portion and an outer sheath portion, eachportion coupled to a separate instrument driver from the set ofinstrument drivers 28, each instrument driver coupled to the distal endof an individual robotic arm. This linear arrangement of the instrumentdrivers 28, which facilitates coaxially aligning the leader portion withthe sheath portion, creates a “virtual rail” 29 that may be repositionedin space by manipulating the one or more robotic arms 12 into differentangles and/or positions. The virtual rails described herein are depictedin the Figures using dashed lines, and accordingly the dashed lines donot depict any physical structure of the system. Translation of theinstrument drivers 28 along the virtual rail 29 telescopes the innerleader portion relative to the outer sheath portion or advances orretracts the endoscope 13 from the patient. The angle of the virtualrail 29 may be adjusted, translated, and pivoted based on clinicalapplication or physician preference. For example, in bronchoscopy, theangle and position of the virtual rail 29 as shown represents acompromise between providing physician access to the endoscope 13 whileminimizing friction that results from bending the endoscope 13 into thepatient’s mouth.

The endoscope 13 may be directed down the patient’s trachea and lungsafter insertion using precise commands from the robotic system untilreaching the target destination or operative site. In order to enhancenavigation through the patient’s lung network and/or reach the desiredtarget, the endoscope 13 may be manipulated to telescopically extend theinner leader portion from the outer sheath portion to obtain enhancedarticulation and greater bend radius. The use of separate instrumentdrivers 28 also allows the leader portion and sheath portion to bedriven independently of each other.

For example, the endoscope 13 may be directed to deliver a biopsy needleto a target, such as, for example, a lesion or nodule within the lungsof a patient. The needle may be deployed down a working channel thatruns the length of the endoscope to obtain a tissue sample to beanalyzed by a pathologist. Depending on the pathology results,additional tools may be deployed down the working channel of theendoscope for additional biopsies. After identifying a nodule to bemalignant, the endoscope 13 may endoscopically deliver tools to resectthe potentially cancerous tissue. In some instances, diagnostic andtherapeutic treatments can be delivered in separate procedures. In thosecircumstances, the endoscope 13 may also be used to deliver a fiducialto “mark” the location of the target nodule as well. In other instances,diagnostic and therapeutic treatments may be delivered during the sameprocedure.

The system 10 may also include a movable tower 30, which may beconnected via support cables to the cart 11 to provide support forcontrols, electronics, fluidics, optics, sensors, and/or power to thecart 11. Placing such functionality in the tower 30 al I ows for asmaller form factor cart 11 that may be more easily adjusted and/orre-positioned by an operating physician and his/her staff. Additionally,the division of functionality between the cart / table and the supporttower 30 reduces operating room clutter and facilitates improvingclinical workflow. While the cart. 11 may be positioned close to thepatient, the tower 30 may be stowed in a remote location to stay out ofthe way during a procedure.

In support of the robotic systems described above, the tower 30 mayinclude component(s) of a computer-based control system that storescomputer program instructions, for example, within a non-transitorycomputer-readable storage medium such as a persistent magnetic storagedrive, solid state drive, etc. The execution of those instructions,whether the execution occurs in the tower 30 or the cart 11, may controlthe entire system or sub-system(s) thereof. For example, when executedby a processor of the computer system, the instructions may cause thecomponents of the robotics system to actuate the relevant carriages andarm mounts, actuate the robotics arms, and control the medicalinstruments. For example, in response to receiving the control signal,the motors in the joints of the robotics arms may position the arms intoa certain posture.

The tower 30 may also include a pump, flow meter, valve control, and/orfluid access in order to provide controlled irrigation and aspirationcapabilities to the system that may be deployed through the endoscope13. These components may also be controlled using the computer system ofthe tower 30. In some embodiments, irrigation and aspirationcapabilities may be delivered directly to the endoscope 13 throughseparate cable(s).

The tower 30 may include a voltage and surge protector designed toprovide filtered and protected electrical power to the cart 11, therebyavoiding placement of a power transformer and other auxiliary powercomponents in the cart 11, resulting in a smaller, more moveable cart11.

The tower 30 may also include support equipment for the sensors deployedthroughout the robotic system 10. For example, the tower 30 may includeoptoelectronics equipment for detecting, receiving, and processing datareceived from the optical sensors or cameras throughout the roboticsystem 10. In combination with the control system, such optoelectronicsequipment may be used to generate real-time images for display in anynumber of consoles deployed throughout the system, including in thetower 30. Similarly, the tower 30 may also include an electronicsubsystem for receiving and processing signals received from deployedelectromagnetic (EM) sensors. The tower 30 may also be used to house andposition an EM field generator for detection by EM sensors in or on themedical instrument.

The tower 30 may also include a console 31 in addition to other consolesavailable in the rest of the system, e.g., console mounted on top of thecart. The console 31 may include a user interface and a display screen,such as a touchscreen, for the physician operator. Consoles in thesystem 10 are generally designed to provide both robotic controls aswell as preoperative and real-time information of the procedure, such asnavigational and localization information of the endoscope 13. When theconsole 31 is not the only console available to the physician, it may beused by a second operator, such as a nurse, to monitor the health orvitals of the patient and the operation of the system 10, as well as toprovide procedure-specific data, such as navigational and localizationinformation. In other embodiments, the console 30 is housed in a bodythat is separate from the tower 30.

The tower 30 may be coupled to the cart 11 and endoscope 13 through oneor more cables or connections (not shown). In some embodiments, thesupport functionality from the tower 30 may be provided through a singlecable to the cart 11, simplifying and de-cluttering the operating room.In other embodiments, specific functionality may be coupled in separatecabling and connections. For example, while power may be providedthrough a single power cable to the cart 11, the support for controls,optics, fluidics, and/or navigation may be provided through a separatecable.

FIG. 2 provides a detailed illustration of an embodiment of the cart 11from the cart-based robotically-enabled system shown in FIG. 1 . Thecart 11 generally includes an elongated support structure 14 (oftenreferred to as a “column”), a cart base 15, and a console 16 at the topof the column 14. The column 14 may include one or more carriages, suchas a carriage 17 (alternatively “arm support”) for supporting thedeployment of one or more robotic arms 12 (three shown in FIG. 2 ). Thecarriage 17 may include individually configurable arm mounts that rotatealong a perpendicular axis to adjust the base of the robotic arms 12 forbetter positioning relative to the patient. The carriage 17 alsoincludes a carriage interface 19 that allows the carriage 17 tovertically translate along the column 14.

The carriage interface 19 is connected to the column 14 through slots,such as slot 20, that are positioned on opposite sides of the column 14to guide the vertical translation of the carriage 17. The slot 20contains a vertical translation interface to position and hold thecarriage 17 at various vertical heights relative to the cart base 15.Vertical translation of the carriage 17 allows the cart 11 to adjust thereach of the robotic arms 12 to meet a variety of table heights, patientsizes, and physician preferences. Similarly, the individuallyconfigurable arm mounts on the carriage 17 allow the robotic arm base 21of the robotic arms 12 to be angled in a variety of configurati ons.

In some embodiments, the slot 20 may be supplemented with slot coversthat are flush and parallel to the slot surface to prevent dirt andfluid ingress into the internal chambers of the column 14 and thevertical translation interface as the carriage 17 vertically translates.The slot covers may be deployed through pairs of spring spoolspositioned near the vertical top and bottom of the slot 20. The coversare coiled within the spools until deployed to extend and retract fromtheir coiled state as the carriage 17 vertically translates up and down.The spring-loading of the spools provides force to retract the coverinto a spool when the carriage 17 translates towards the spool, whilealso maintaining a tight seal when the carriage 17 translates away fromthe spool. The covers may be connected to the carriage 17 using, forexample, brackets in the carriage interface 19 to ensure properextension and retraction of the cover as the carriage 17 translates.

The column 14 may internally comprise mechanisms, such as gears andmotors, that are designed to use a vertically aligned lead screw totranslate the carriage 17 in a mechanized fashion in response to controlsignals generated in response to user inputs, e.g., inputs from theconsole 16.

The robotic arms 12 may generally comprise robotic arm bases 21 and endeffectors 22, separated by a series of linkages 23 that are connected bya series of joints 24, each joint comprising an independent actuator,each actuator comprising an independently controllable motor. Eachindependently controllable joint represents an independent degree offreedom available to the robotic arm 12. Each of the robotic arms 12 mayhave seven joints, and thus provide seven degrees of freedom. Amultitude of joints result in a multitude of degrees of freedom,allowing for “redundant” degrees of freedom. Having redundant degrees offreedom allows the robotic arms 12 to position their respective endeffectors 22 at a specific position, orientation, and trajectory inspace using different linkage positions and joint angles. This allowsfor the system to position and direct a medical instrument from adesired point in space while allowing the physician to move the armjoints into a clinically advantageous position away from the patient tocreate greater access, while avoiding arm collisions.

The cart base 15 balances the weight of the column 14, carriage 17, androbotic arms 12 over the floor. Accordingly, the cart base 15 housesheavier components, such as electronics, motors, power supply, as wellas components that either enable movement and/or immobilize the cart 11.For example, the cart base 15 includes rollable wheel-shaped casters 25that allow for the cart 11 to easily move around the room prior to aprocedure. After reaching the appropriate position, the casters 25 maybe immobilized using wheel locks to hold the cart 11 in place during theprocedure.

Positioned at the vertical end of the column 14, the console 16 allowsfor both a user interface for receiving user input and a display screen(or a dual-purpose device such as, for example, a touchscreen 26) toprovide the physician user with both preoperative and intraoperativedata. Potential preoperative data on the touchscreen 26 may includepreoperative plans, navigation and mapping data derived frompreoperative computerized tomography (CT) scans, and/or notes frompreoperative patient interviews. Intraoperative data on display mayinclude optical information provided from the tool, sensor andcoordinate information from sensors, as well as vital patientstatistics, such as respiration, heart rate, and/or pulse. The console16 may be positioned and tilted to allow a physician to access theconsole 16 from the side of the column 14 opposite the carriage 17. Fromthis position, the physician may view the console 16, robotic arms 12,and patient while operating the console 16 from behind the cart 11. Asshown, the console 16 also includes a handle 27 to assist withmaneuvering and stabilizing the cart 11.

FIG. 3 illustrates an embodiment of a robotically-enabled system 10arranged for ureteroscopy. In a ureteroscopic procedure, the cart 11 maybe positioned to deliver a ureteroscope 32, a procedure-specificendoscope designed to traverse a patient’s urethra and ureter, to thelower abdominal area of the patient. In a ureteroscopy, it may bedesirable for the ureteroscope 32 to be directly aligned with thepatient’s urethra to reduce friction and forces on the sensitive anatomyin the area. As shown, the cart 11 may be aligned at the foot of thetable to allow the robotic arms 12 to position the ureteroscope 32 fordirect linear access to the patient’s urethra. From the foot of thetable, the robotic arms 12 may insert the ureteroscope 32 along thevirtual rail 33 directly into the patient’s lower abdomen through theurethra.

After insertion into the urethra, using similar control techniques as inbronchoscopy, the ureteroscope 32 may be navigated into the bladder,ureters, and/or kidneys for diagnostic and/or therapeutic applications.For example, the ureteroscope 32 may be directed into the ureter andkidneys to break up kidney stone build up using a laser or ultrasoniclithotripsy device deployed down the working channel of the ureteroscope32. After lithotripsy is complete, the resulting stone fragments may beremoved using baskets deployed down the ureteroscope 32.

FIG. 4 illustrates an embodiment of a robotically-enabled system 10similarly arranged for a vascular procedure. In a vascular procedure,the system 10 may be configured such that the cart 11 may deliver amedical instrument 34, such as a steerable catheter, to an access pointin the femoral artery in the patient’s leg. The femoral artery presentsboth a larger diameter for navigation as well as a relatively lesscircuitous and tortuous path to the patient’s heart, which simplifiesnavigation. As in a ureteroscopic procedure, the cart 11 may bepositioned towards the patient’s legs and lower abdomen to allow therobotic arms 12 to provide a virtual rail 35 with direct linear accessto the femoral artery access point in the patient’s thigh / hip region.After insertion into the artery, the medical instrument 34 may bedirected and inserted by translating the instrument drivers 28.Alternatively, the cart may be positioned around the patient’s upperabdomen in order to reach alternative vascular access points, such as,for example, the carotid and brachial arteries near the shoulder andwrist.

B. Robotic System ― Table

Embodiments of the robotically-enabled medical system may alsoincorporate the patient’s table. Incorporation of the table reduces theamount of capital equipment within the operating room by removing thecart, which allows greater access to the patient. FIG. 5 illustrates anembodiment of such a robotically-enabled system arranged for abronchoscopic procedure. System 36 includes a support structure orcolumn 37 for supporting platform 38 (shown as a “table” or “bed”) overthe floor. Much like in the cart-based systems, the end effectors of therobotic arms 39 of the system 36 comprise instrument drivers 42 that aredesigned to manipulate an elongated medical instrument, such as abronchoscope 40 in FIG. 5 , through or along a virtual rail 41 formedfrom the linear alignment of the instrument drivers 42. In practice, aC-arm for providing fluoroscopic imaging may be positioned over thepatient’s upper abdominal area by placing the emitter and detectoraround the table 38.

FIG. 6 provides an alternative view of the system 36 without the patientand medical instrument for discussion purposes. As shown, the column 37may include one or more carriages 43 shown as ring-shaped in the system36, from which the one or more robotic arms 39 may be based. Thecarriages 43 may translate along a vertical column interface 44 thatruns the length of the column 37 to provide different vantage pointsfrom which the robotic arms 39 may be positioned to reach the patient.The carriage(s) 43 may rotate around the column 37 using a mechanicalmotor positioned within the column 37 to allow the robotic arms 39 tohave access to multiples sides of the table 38, such as, for example,both sides of the patient. In embodiments with multiple carriages, thecarriages may be individually positioned on the column and may translateand/or rotate independently of the other carriages. While the carriages43 need not surround the column 37 or even be circular, the ring-shapeas shown facilitates rotation of the carriages 43 around the column 37while maintaining structural balance. Rotation and translation of thecarriages 43 allows the system 36 to align the medical instruments, suchas endoscopes and laparoscopes, into different access points on thepatient. In other embodiments (not shown), the system 36 can include apatient table or bed with adjustable arm supports in the form of bars orrails extending alongside it. One or more robotic arms 39 (e.g., via ashoulder with an elbow joint) can be attached to the adjustable armsupports, which can be vertically adjusted. By providing verticaladjustment, the robotic arms 39 are advantageously capable of beingstowed compactly beneath the patient table or bed, and subsequentlyraised during a procedure.

The robotic arms 39 may be mounted on the carriages 43 through a set ofarm mounts 45 comprising a series of joints that may individually rotateand/or telescopically extend to provide additional configurability tothe robotic arms 39. Additionally, the arm mounts 45 may be positionedon the carriages 43 such that, when the carriages 43 are appropriatelyrotated, the arm mounts 45 may be positioned on either the same side ofthe table 38 (as shown in FIG. 6 ), on opposite sides of the table 38(as shown in FIG. 9 ), or on adjacent sides of the table 38 (not shown).

The column 37 structurally provides support for the table 38, and a pathfor vertical translation of the carriages 43. Internally, the column 37may be equipped with lead screws for guiding vertical translation of thecarriages, and motors to mechanize the translation of the carriages 43based the lead screws. The column 37 may also convey power and controlsignals to the carriages 43 and the robotic arms 39 mounted thereon.

The table base 46 serves a similar function as the cart base 15 in thecart 11 shown in FIG. 2 , housing heavier components to balance thetable/bed 38, the column 37, the carriages 43, and the robotic arms 39.The table base 46 may also incorporate rigid casters to providestability during procedures. Deployed from the bottom of the table base46, the casters may extend in opposite directions on both sides of thebase 46 and retract when the system 36 needs to be moved.

With continued reference to FIG. 6 , the system 36 may also include atower (not shown) that divides the functionality of the system 36between the table and the tower to reduce the form factor and bulk ofthe table. As in earlier disclosed embodiments, the tower may provide avariety of support functionalities to the table, such as processing,computing, and control capabilities, power, fluidics, and/or optical andsensor processing. The tower may also be movable to be positioned awayfrom the patient to improve physician access and de-clutter theoperating room. Additionally, placing components in the tower allows formore storage space in the table base 46 for potential stowage of therobotic arms 39. The tower may also include a master controller orconsole that provides both a user interface for user input, such askeyboard and/or pendant, as well as a display screen (or touchscreen)for preoperative and intraoperative information, such as real-timeimaging, navigation, and tracking information. In some embodiments, thetower may also contain holders for gas tanks to be used forinsufflation.

In some embodiments, a table base may stow and store the robotic armswhen not in use. FIG. 7 illustrates a system 47 that stows robotic armsin an embodiment of the table-based system. In the system 47, carriages48 may be vertically translated into base 49 to stow robotic arms 50,arm mounts 51, and the carriages 48 within the base 49. Base covers 52may be translated and retracted open to deploy the carriages 48, armmounts 51, and robotic arms 50 around column 53, and closed to stow toprotect them when not in use. The base covers 52 may be sealed with amembrane 54 along the edges of its opening to prevent dirt and fluidingress when closed.

FIG. 8 illustrates an embodiment of a robotically-enabled table-basedsystem configured for a ureteroscopic procedure. In a ureteroscopy, thetable 38 may include a swivel portion 55 for positioning a patientoff-angle from the column 37 and table base 46. The swivel portion 55may rotate or pivot around a pivot point (e.g., located below thepatient’s head) in order to position the bottom portion of the swivelportion 55 away from the column 37. For example, the pivoting of theswivel portion 55 allows a C-arm (not shown) to be positioned over thepatient’s lower abdomen without competing for space with the column (notshown) below table 38. By rotating the carriage 35 (not shown) aroundthe column 37, the robotic arms 39 may directly insert a ureteroscope 56along a virtual rail 57 into the patient’s groin area to reach theurethra. In a ureteroscopy, stirrups 58 may also be fixed to the swivelportion 55 of the table 38 to support the position of the patient’s legsduring the procedure and allow clear access to the patient’s groin area.

In a laparoscopic procedure, through small incision(s) in the patient’sabdominal wall, minimally invasive instruments may be inserted into thepatient’s anatomy. In some embodiments, the minimally invasiveinstruments comprise an elongated rigid member, such as a shaft, whichis used to access anatomy within the patient. After inflation of thepatient’s abdominal cavity, the instruments may be directed to performsurgical or medical tasks, such as grasping, cutting, ablating,suturing, etc. In some embodiments, the instruments can comprise ascope, such as a laparoscope. FIG. 9 illustrates an embodiment of arobotically-enabled table-based system configured for a laparoscopicprocedure. As shown in FIG. 9 , the carriages 43 of the system 36 may berotated and vertically adjusted to position pairs of the robotic arms 39on opposite sides of the table 38, such that instrument 59 may bepositioned using the arm mounts 45 to be passed through minimalincisions on both sides of the patient to reach his/her abdominalcavity.

To accommodate laparoscopic procedures, the robotically-enabled tablesystem may also tilt the platform to a desired angle. FIG. 10illustrates an embodiment of the robotically-enabled medical system withpitch or tilt adjustment. As shown in FIG. 10 , the system 36 mayaccommodate tilt of the table 38 to position one portion of the table ata greater distance from the floor than the other. Additionally, the armmounts 45 may rotate to match the tilt such that the robotic arms 39maintain the same planar relationship with the table 38. To accommodatesteeper angles, the column 37 may also include telescoping portions 60that allow vertical extension of the column 37 to keep the table 38 fromtouching the floor or colliding with the table base 46.

FIG. 11 provides a detailed illustration of the interface between thetable 38 and the column 37. Pitch rotation mechanism 61 may beconfigured to alter the pitch angle of the table 38 relative to thecolumn 37 in multiple degrees of freedom. The pitch rotation mechanism61 may be enabled by the positioning of orthogonal axes 1, 2 at thecolumn-table interface, each axis actuated by a separate motor 3, 4responsive to an electrical pitch angle command. Rotation along onescrew 5 would enable tilt adjustments in one axis 1, while rotationalong the other screw 6 would enable tilt adjustments along the otheraxis 2. In some embodiments, a ball joint can be used to alter the pitchangle of the table 38 relative to the column 37 in multiple degrees offreedom.

For example, pitch adjustments are particularly useful when trying toposition the table in a Trendelenburg position, i.e., position thepatient’s lower abdomen at a higher position from the floor than thepatient’s upper abdomen, for lower abdominal surgery. The Trendelenburgposition causes the patient’s internal organs to slide towards his/herupper abdomen through the force of gravity, clearing out the abdominalcavity for minimally invasive tools to enter and perform lower abdominalsurgical or medical procedures, such as laparoscopic prostatectomy.

FIGS. 12 and 13 illustrate isometric and end views of an alternativeembodiment of a table-based surgical robotics system 100. The surgicalrobotics system 100 includes one or more adjustable arm supports 105that can be configured to support one or more robotic arms (see, forexample, FIG. 14 ) relative to a table 101. In the illustratedembodiment, a single adjustable arm support 105 is shown, though anadditional arm support can be provided on an opposite side of the table101. The adjustable arm support 105 can be configured so that it canmove relative to the table 101 to adjust and/or vary the position of theadjustable arm support 105 and/or any robotic arms mounted theretorelative to the table 101. For example, the adjustable arm support 105may be adjusted one or more degrees of freedom relative to the table101. The adjustable arm support 105 provides high versatility to thesystem 100, including the ability to easily stow the one or moreadjustable arm supports 105 and any robotics arms attached theretobeneath the table 101. The adjustable arm support 105 can be elevatedfrom the stowed position to a position below an upper surface of thetable 101. In other embodiments, the adjustable arm support 105 can beelevated from the stowed position to a position above an upper surfaceof the table 101.

The adjustable arm support 105 can provide several degrees of freedom,including lift, lateral translation, tilt, etc. In the illustratedembodiment of FIGS. 12 and 13 , the arm support 105 is configured withfour degrees of freedom, which are illustrated with arrows in FIG. 12 .A first degree of freedom allows for adjustment of the adjustable armsupport 105 in the z-direction (“Z-lift”). For example, the adjustablearm support 105 can include a carriage 109 configured to move up or downalong or relative to a column 102 supporting the table 101. A seconddegree of freedom can allow the adjustable arm support 105 to tilt. Forexample, the adjustable arm support 105 can include a rotary joint,which can allow the adjustable arm support 105 to be aligned with thebed in a Trendelenburg position. A third degree of freedom can allow theadjustable arm support 105 to “pivot up,” which can be used to adjust adistance between a side of the table 101 and the adjustable arm support105. A fourth degree of freedom can permit translation of the adjustablearm support 105 along a longitudinal length of the table.

The surgical robotics system 100 in FIGS. 12 and 13 can comprise a tablesupported by a column 102 that is mounted to a base 103. The base 103and the column 102 support the table 101 relative to a support surface.A floor axis 131 and a support axis 133 are shown in FIG. 13 .

The adjustable arm support 105 can be mounted to the column 102. Inother embodiments, the arm support 105 can be mounted to the table 101or base 103. The adjustable arm support 105 can include a carriage 109,a bar or rail connector 111 and a bar or rail 107. In some embodiments,one or more robotic arms mounted to the rail 107 can translate and moverelative to one another.

The carriage 109 can be attached to the column 102 by a first joint 113,which allows the carriage 109 to move relative to the column 102 (e.g.,such as up and down a first or vertical axis 123). The first joint 113can provide the first degree of freedom (“Z-lift”) to the adjustable armsupport 105. The adjustable arm support 105 can include a second joint115, which provides the second degree of freedom (tilt) for theadjustable arm support 105. The adjustable arm support 105 can include athird joint 117, which can provide the third degree of freedom (“pivotup”) for the adjustable arm support 105. An additional joint 119 (shownin FIG. 13 ) can be provided that mechanically constrains the thirdjoint 117 to maintain an orientation of the rail 107 as the railconnector 111 is rotated about a third axis 127. The adjustable armsupport 105 can include a fourth joint 121, which can provide a fourthdegree of freedom (translation) for the adjustable arm support 105 alonga fourth axis 129.

FIG. 14 illustrates an end view of the surgical robotics system 140Awith two adjustable arm supports 105A, 105B mounted on opposite sides ofa table 101. A first robotic arm 142A is attached to the bar or rail107A of the first adjustable arm support 105B. The first robotic arm142A includes a base 144A attached to the rail 107A. The distal end ofthe first robotic arm 142A. includes an instrument drive mechanism 146Athat can attach to one or more robotic medical instruments or tools.Similarly, the second robotic arm 142B includes a base 144B attached tothe rail 107B. The distal end of the second robotic arm 142B includes aninstrument drive mechanism 146B. The instrument drive mechanism 146B canbe configured to attach to one or more robotic medical instruments ortools.

In some embodiments, one or more of the robotic arms 142A, 142Bcomprises an arm with seven or more degrees of freedom. In someembodiments, one or more of the robotic arms 142A, 142B can includeeight degrees of freedom, including an insertion axis (1-degree offreedom including insertion), a wrist (3-degrees of freedom includingwrist pitch, yaw and roll), an elbow (1-degree of freedom includingelbow pitch), a shoulder (2-degrees of freedom including shoulder pitchand yaw), and base 144A, 144B (1-degree of freedom includingtranslation). In some embodiments, the insertion degree of freedom canbe provided by the robotic arm 142A, 142B, while in other embodiments,the instrument itself provides insertion via an instrument-basedinsertion architecture.

C. Instrument Driver & Interface

The end effectors of the system’s robotic arms may comprise (i) aninstrument driver (alternatively referred to as “instrument drivemechanism” or “instrument device manipulator”) that incorporateselectro-mechanical means for actuating the medical instrument and (ii) aremovable or detachable medical instrument, which may be devoid of anyelectro-mechanical components, such as motors. This dichotomy may bedriven by the need to sterilize medical instruments used in medicalprocedures, and the inability to adequately sterilize expensive capitalequipment due to their intricate mechanical assemblies and sensitiveelectronics. Accordingly, the medical instruments may be designed to bedetached, removed, and interchanged from the instrument driver (and thusthe system) for individual sterilization or disposal by the physician orthe physician’s staff. In contrast, the instrument drivers need not bechanged or sterilized, and may be draped for protection.

FIG. 15 illustrates an example instrument driver. Positioned at thedistal end of a robotic arm, instrument driver 62 comprises one or moredrive units 63 arranged with parallel axes to provide controlled torqueto a medical instrument via drive shafts 64. Each drive unit 63comprises an individual drive shaft 64 for interacting with theinstrument, a gear head 65 for converting the motor shaft rotation to adesired torque, a motor 66 for generating the drive torque, an encoder67 to measure the speed of the motor shaft and provide feedback to thecontrol circuitry, and control circuity 68 for receiving control signalsand actuating the drive unit. Each drive unit 63 being independentlycontrolled and motorized, the instrument driver 62 may provide multiple(e.g., four as shown in FIG. 15 ) independent drive outputs to themedical instrument. In operation, the control circuitry 68 would receivea control signal, transmit a motor signal to the motor 66, compare theresulting motor speed as measured by the encoder 67 with the desiredspeed, and modulate the motor signal to generate the desired torque.

For procedures that require a sterile environment, the robotic systemmay incorporate a drive interface, such as a sterile adapter connectedto a sterile drape, that sits between the instrument driver and themedical instrument. The chief purpose of the sterile adapter is totransfer angular motion from the drive shafts of the instrument driverto the drive inputs of the instrument while maintaining physicalseparation, and thus sterility, between the drive shafts and driveinputs. Accordingly, an example sterile adapter may comprise a series ofrotational inputs and outputs intended to be mated with the drive shaftsof the instrument driver and drive inputs on the instrument. Connectedto the sterile adapter, the sterile drape, comprised of a thin, flexiblematerial such as transparent or translucent plastic, is designed tocover the capital equipment, such as the instrument driver, robotic arm,and cart (in a cart-based system) or table (in a table-based system).Use of the drape would allow the capital equipment to be positionedproximate to the patient while still being located in an area notrequiring sterilization (i.e., non-sterile field). On the other side ofthe sterile drape, the medical instrument may interface with the patientin an area requiring sterilization (i.e., sterile field).

D. Medical Instrument

FIG. 16 illustrates an example medical instrument with a pairedinstrument driver. Like other instruments designed for use with arobotic system, medical instrument 70 comprises an elongated shaft 71(or elongate body) and an instrument base 72. The instrument base 72,also referred to as an “instrument handle” due to its intended designfor manual interaction by the physician, may generally compriserotatable drive inputs 73, e.g., receptacles, pulleys or spools, thatare designed to be mated with drive outputs 74 that extend through adrive interface on instrument driver 75 at the distal end of robotic arm76. When physically connected, latched, and/or coupled, the mated driveinputs 73 of the instrument base 72 may share axes of rotation with thedrive outputs 74 in the instrument driver 75 to allows the transfer oftorque from the drive outputs 74 to the drive inputs 73. In someembodiments, the drive outputs 74 may comprise splines that are designedto mate with receptacles on the drive inputs 73.

The elongated shaft 71 is designed to be delivered through either ananatomical opening or lumen, e.g., as in endoscopy, or a minimallyinvasive incision, e.g., as in laparoscopy. The elongated shaft 71 maybe either flexible (e.g., having properties similar to an endoscope) orrigid (e.g., having properties similar to a laparoscope) or contain acustomized combination of both flexible and rigid portions. Whendesigned for laparoscopy, the distal end of a rigid elongated shaft maybe connected to an end effector extending from a jointed wrist formedfrom a clevis with at least one degree of freedom and a surgical tool ormedical instrument, such as, for example, a grasper or scissors, thatmay be actuated based on force from the tendons as the drive inputsrotate in response to torque received from the drive outputs 74 of theinstrument driver 75. When designed for endoscopy, the distal end of aflexible elongated shaft may include a steerable or controllable bendingsection that may be articulated and bent based on torque received fromthe drive outputs 74 of the instrument driver 75.

Torque from the instrument driver 75 is transmitted down the elongatedshaft 71 using tendons along the elongated shaft 71. These individualtendons, such as pull wires, may be individually anchored to individualdrive inputs 73 within the instrument handle 72. From the handle 72, thetendons are directed down one or more pull lumens along the elongatedshaft 71 and anchored at the distal portion of the elongated shaft 71,or in the wrist at the distal portion of the elongated shaft. During asurgical procedure, such as a laparoscopic, endoscopic or hybridprocedure, these tendons may be coupled to a distally mounted endeffector, such as a wrist, grasper, or scissor. Under such anarrangement, torque exerted on drive inputs 73 would transfer tension tothe tendon, thereby causing the end effector to actuate in some way. Insome embodiments, during a surgical procedure, the tendon may cause ajoint to rotate about an axis, thereby causing the end effector to movein one direction or another. Alternatively, the tendon may be connectedto one or more jaws of a grasper at the distal end of the elongatedshaft 71, where tension from the tendon causes the grasper to close.

In endoscopy, the tendons may be coupled to a bending or articulatingsection positioned along the elongated shaft 71 (e.g., at the distalend) via adhesive, control ring, or other mechanical fixation. Whenfixedly attached to the distal end of a bending section, torque exertedon the drive inputs 73 would be transmitted down the tendons, causingthe softer, bending section (sometimes referred to as the articulablesection or region) to bend or articulate. Along the non-bendingsections, it may be advantageous to spiral or helix the individual pulllumens that direct the individual tendons along (or inside) the walls ofthe endoscope shaft to balance the radial forces that result fromtension in the pull wires. The angle of the spiraling and/or spacingtherebetween may be altered or engineered for specific purposes, whereintighter spiraling exhibits lesser shaft compression under load forces,while lower amounts of spiraling results in greater shaft compressionunder load forces, but limits bending On the other end of the spectrum,the pull lumens may be directed parallel to the longitudinal axis of theelongated shaft 71 to allow for controlled articulation in the desiredbending or articulable sections.

In endoscopy, the elongated shaft 71 houses a number of components toassist with the robotic procedure. The shaft 71 may comprise a workingchannel for deploying surgical tools (or medical instruments),irrigation, and/or aspiration to the operative region at the distal endof the shaft 71. The shaft 71 may also accommodate wires and/or opticalfibers to transfer signals to/from an optical assembly at the distaltip, which may include an optical camera. The shaft 71 may alsoaccommodate optical fibers to carry light from proximally-located lightsources, such as light emitting diodes, to the distal end of the shaft71.

At the distal end of the instrument 70, the distal tip may also comprisethe opening of a working channel for delivering tools for diagnosticand/or therapy, irrigation, and aspiration to an operative site. Thedistal tip may also include a port for a camera, such as a fiberscope ora digital camera, to capture images of an internal anatomical space.Relatedly, the distal tip may also include ports for light sources forilluminating the anatomical space when using the camera.

In the example of FIG. 16 , the drive shaft axes, and thus the driveinput axes, are orthogonal to the axis of the elongated shaft 71. Thisarrangement, however, complicates roll capabilities for the elongatedshaft 71. Rolling the elongated shaft 71 along its axis while keepingthe drive inputs 73 static results in undesirable tangling of thetendons as they extend off the drive inputs 73 and enter pull lumenswithin the elongated shaft 71. The resulting entanglement of suchtendons may disrupt any control algorithms intended to predict movementof the flexible elongated shaft 71 during an endoscopic procedure.

FIG. 17 illustrates an alternative design for an instrument driver andinstrument where the axes of the drive units are parallel to the axis ofthe elongated shaft of the instrument. As shown, a circular instrumentdriver 80 comprises four drive units with their drive outputs 81 alignedin parallel at the end of a robotic arm 82. The drive units, and theirrespective drive outputs 81, are housed in a rotational assembly 83 ofthe instrument driver 80 that is driven by one of the drive units withinthe assembly 83. In response to torque provided by the rotational driveunit, the rotational assembly 83 rotates along a circular bearing thatconnects the rotational assembly 83 to the non-rotational portion 84 ofthe instrument driver 80. Power and controls signals may be communicatedfrom the non-rotational portion 84 of the instrument driver 80 to therotational assembly 83 through electrical contacts that may bemaintained through rotation by a brushed slip ring connection (notshown). In other embodiments, the rotational assembly 83 may beresponsive to a separate drive unit that is integrated into thenon-rotatable portion 84, and thus not in parallel to the other driveunits. The rotational mechanism 83 allows the instrument driver 80 torotate the drive units, and their respective drive outputs 81, as asingle unit around an instrument driver axis 85.

Like earlier disclosed embodiments, an instrument 86 may comprise anelongated shaft portion 88 and an instrument base 87 (shown with atransparent external skin for discussion purposes) comprising aplurality of drive inputs 89 (such as receptacles, pulleys, and spools)that are configured to receive the drive outputs 81 in the instrumentdriver 80. Unlike prior disclosed embodiments, the instrument shaft 88extends from the center of the instrument base 87 with an axissubstantially parallel to the axes of the drive inputs 89, rather thanorthogonal as in the design of FIG. 16 .

When coupled to the rotational assembly 83 of the instrument driver 80,the medical instrument 86, comprising instrument base 87 and instrumentshaft 88, rotates in combination with the rotational assembly 83 aboutthe instrument driver axis 85. Since the instrument shaft 88 ispositioned at the center of instrument base 87, the instrument shaft 88is coaxial with instrument driver axis 85 when attached. Thus, rotationof the rotational assembly 83 causes the instrument shaft 88 to rotateabout its own longitudinal axis. Moreover, as the instrument base 87rotates with the instrument shaft 88, any tendons connected to the driveinputs 89 in the instrument base 87 are not tangled during rotation.Accordingly, the parallelism of the axes of the drive outputs 81, driveinputs 89, and instrument shaft 88 allows for the shaft rotation withouttangling any control tendons.

FIG. 18 illustrates an instrument having an instrument based insertionarchitecture in accordance with some embodiments. The instrument 150 canbe coupled to any of the instrument drivers discussed above. Theinstrument 150 comprises an elongated shaft 152, an end effector 162connected to the shaft 152, and a handle 170 coupled to the shaft 152.The elongated shaft 152 comprises a tubular member having a proximalportion 154 and a distal portion 156. The elongated shaft 152 comprisesone or more channels or grooves 158 along its outer surface. The grooves158 are configured to receive one or more wires or cables 180therethrough. One or more cables 180 thus run along an outer surface ofthe elongated shaft 152. In other embodiments, cables 180 can also runthrough the elongated shaft 152. Manipulation of the one or more cables180 (e.g., via an instrument driver) results in actuation of the endeffector 162.

The instrument handle 170, which may also be referred to as aninstrument base, may generally comprise an attachment interface 172having one or more mechanical inputs 174, e.g., receptacles, pulleys orspools, that are designed to be reciprocally mated with one or moretorque couplers on an attachment surface of an instrument driver.

In some embodiments, the instrument 150 comprises a series of pulleys orcables that enable the elongated shaft 152 to translate relative to thehandle 170. In other words, the instrument 150 itself comprises aninstrument-based insertion architecture that accommodates insertion ofthe instrument, thereby minimizing the reliance on a robot arm toprovide insertion of the instrument 150. In other embodiments, a roboticarm can be largely responsible for instrument insertion.

E. Controller

Any of the robotic systems described herein can include an input deviceor controller for manipulating an instrument attached to a robotic arm.In some embodiments, the controller can be coupled (e.g.,communicatively, electronically, electrically, wirelessly and/ormechanically) with an instrument such that manipulation of thecontroller causes a corresponding manipulation of the instrument e.g.,via master slave control.

FIG. 19 is a perspective view of an embodiment of a controller 182. Inthe present embodiment, the controller 182 comprises a hybrid controllerthat can have both impedance and admittance control. In otherembodiments, the controller 182 can utilize just impedance or passivecontrol. In other embodiments, the controller 182 can utilize justadmittance control. By being a hybrid controller, the controller 182advantageously can have a lower perceived inertia while in use.

In the illustrated embodiment, the controller 182 is configured to allowmanipulation of two medical instruments, and includes two handles 184.Each of the handles 184 is connected to a gimbal 186. Each gimbal 186 isconnected to a positioning platform 188.

As shown in FIG. 19 , each positioning platform 188 includes a SCARA arm(selective compliance assembly robot arm) 198 coupled to a column 194 bya prismatic joint 196. The prismatic joints 196 are configured totranslate along the column 194 (e.g., along rails 197) to allow each ofthe handles 184 to be translated in the z-direction, providing a firstdegree of freedom. The SCARA arm 198 is configured to allow motion ofthe handle 184 in an x-y plane, providing two additional degrees offreedom.

In some embodiments, one or more load cells are positioned in thecontroller. For example, in some embodiments, a load cell (not shown) ispositioned in the body of each of the gimbals 186. By providing a loadcell, portions of the controller 182 are capable of operating underadmittance control, thereby advantageously reducing the perceivedinertia of the controller while in use. In some embodiments, thepositioning platform 188 is configured for admittance control, while thegimbal 186 is configured for impedance control. In other embodiments,the gimbal 186 is configured for admittance control, while thepositioning platform 188 is configured for impedance control.Accordingly, for some embodiments, the translational or positionaldegrees of freedom of the positioning platform 188 can rely onadmittance control, while the rotational degrees of freedom of thegimbal 186 rely on impedance control.

F. Navigation and Control

Traditional endoscopy may involve the use of fluoroscopy (e.g., as maybe delivered through a C-arm) and other forms of radiation-based imagingmodalities to provide endoluminal guidance to an operator physician. Incontrast, the robotic systems contemplated by this disclosure canprovide for non-radiation-based navigational and localization means toreduce physician exposure to radiation and reduce the amount ofequipment within the operating room. As used herein, the term“localization” may refer to determining and/or monitoring the positionof objects in a reference coordinate system. Technologies such aspreoperative mapping, computer vision, real-time EM tracking, and robotcommand data may be used individually or in combination to achieve aradiation-free operating environment. In other cases, whereradiation-based imaging modalities are still used, the preoperativemapping, computer vision, real-time EM tracking, and robot command datamay be used individually or in combination to improve upon theinformation obtained solely through radiation-based imaging modalities.

FIG. 20 is a block diagram illustrating a localization system 90 thatestimates a location of one or more elements of the robotic system, suchas the location of the instrument, in accordance to an exampleembodiment. The localization system 90 may be a set of one or morecomputer devices configured to execute one or more instructions. Thecomputer devices may be embodied by a processor (or processors) andcomputer-readable memory in one or more components discussed above. Byway of example and not limitation, the computer devices may be in thetower 30 shown in FIG. 1 , the cart 11 shown in FIGS. 1-4 , the bedsshown in FIGS. 5-14 , etc.

As shown in FIG. 20 , the localization system 90 may include alocalization module 95 that processes input data 91-94 to generatelocation data 96 for the distal tip of a medical instrument. Thelocation data 96 may be data or logic that represents a location and/ororientation of the distal end of the instrument relative to a frame ofreference. The frame of reference can be a frame of reference relativeto the anatomy of the patient or to a known object, such as an EM fieldgenerator (see discussion below for the EM field generator).

The various input data 91-94 are now described in greater detail.Preoperative mapping may be accomplished through the use of thecollection of low dose CT scans. Preoperative CT scans are reconstructedinto three-dimensional images, which are visualized, e.g. as “slices” ofa cutaway view of the patient’s internal anatomy. When analyzed in theaggregate, image-based models for anatomical cavities, spaces andstructures of the patient’s anatomy, such as a patient lung network, maybe generated. Techniques such as center-line geometry may be determinedand approximated from the CT images to develop a three-dimensionalvolume of the patient’s anatomy, referred to as model data 91 (alsoreferred to as “preoperative model data” when generated using onlypreoperative CT scans). The use of center-line geometry is discussed inU.S. Pat. App. No. 14/523,760, the contents of which are hereinincorporated in its entirety. Network topological models may also bederived from the CT-images, and are particularly appropriate forbronchoscopy.

In some embodiments, the instrument may be equipped with a camera toprovide vision data (or image data) 92. The localization module 95 mayprocess the vision data 92 to enable one or more vision-based (orimage-based) location tracking modules or features. For example, thepreoperative model data 91 may be used in conjunction with the visiondata 92 to enable computer vision-based tracking of the medicalinstrument (e.g., an endoscope or an instrument advance through aworking channel of the endoscope). For example, using the preoperativemodel data 91, the robotic system may generate a library of expectedendoscopic images from the model based on the expected path of travel ofthe endoscope, each image linked to a location within the model.Intraoperatively, this library may be referenced by the robotic systemin order to compare real-time images captured at the camera (e.g., acamera at a distal end of the endoscope) to those in the image libraryto assist localization.

Other computer vision-based tracking techniques use feature tracking todetermine motion of the camera, and thus the endoscope. Some features ofthe localization module 95 may identify circular geometries in thepreoperative model data 91 that correspond to anatomical lumens andtrack the change of those geometries to determine which anatomical lumenwas selected, as well as the relative rotational and/or translationalmotion of the camera. Use of a topological map may further enhancevision-based algorithms or techniques.

Optical flow, another computer vision-based technique, may analyze thedisplacement and translation of image pixels in a video sequence in thevision data 92 to infer camera movement. Examples of optical flowtechniques may include motion detection, object segmentationcalculations, luminance, motion compensated encoding, stereo disparitymeasurement, etc. Through the comparison of multiple frames overmultiple iterations, movement and location of the camera (and thus theendoscope) may be determined.

The localization module 95 may use real-time EM tracking to generate areal-time location of the endoscope in a global coordinate system thatmay be registered to the patient’s anatomy, represented by thepreoperative model. In EM tracking, an EM sensor (or tracker) comprisingone or more sensor coils embedded in one or more locations andorientations in a medical instrument (e.g., an endoscopic tool) measuresthe variation in the EM field created by one or more static EM fieldgenerators positioned at a known location. The location informationdetected by the EM sensors is stored as EM data 93. The EM fieldgenerator (or transmitter), may be placed close to the patient to createa low intensity magnetic field that the embedded sensor may detect. Themagnetic field induces small currents in the sensor coils of the EMsensor, which may be analyzed to determine the distance and anglebetween the EM sensor and the EM field generator. These distances andorientations may be intraoperatively “registered” to the patient anatomy(e.g., the preoperative model) in order to determine the geometrictransformation that aligns a single location in the coordinate systemwith a position in the preoperative model of the patient’s anatomy. Onceregistered, an embedded EM tracker in one or more positions of themedical instrument (e.g., the distal tip of an endoscope) may providereal-time indications of the progression of the medical instrumentthrough the patient’s anatomy.

Robotic command and kinematics data 94 may also be used by thelocalization module 95 to provide localization data 96 for the roboticsystem. Device pitch and yaw resulting from articulation commands may bedetermined during preoperative calibration. Intraoperatively, thesecalibration measurements may be used in combination with known insertiondepth information to estimate the position of the instrument.Alternatively, these calculations may be analyzed in combination withEM, vision, and/or topological modeling to estimate the position of themedical instrument within the network.

As FIG. 20 shows, a number of other input data can be used by thelocalization module 95. For example, although not shown in FIG. 20 , aninstrument utilizing shape-sensing fiber can provide shape data that thelocalization module 95 can use to determine the location and shape ofthe instrument.

The localization module 95 may use the input data 91-94 incombination(s). In some cases, such a combination may use aprobabilistic approach where the localization module 95 assigns aconfidence weight to the location determined from each of the input data91-94. Thus, where the EM data may not be reliable (as may be the casewhere there is EM interference) the confidence of the locationdetermined by the EM data 93 can be decrease and the localization module95 may rely more heavily on the vision data 92 and/or the roboticcommand and kinematics data 94.

As discussed above, the robotic systems discussed herein may be designedto incorporate a combination of one or more of the technologies above.The robotic system’s computer-based control system, based in the tower,bed and/or cart, may store computer program instructions, for example,within a non-transitory computer-readable storage medium such as apersistent magnetic storage drive, solid state drive, or the like, that,upon execution, cause the system to receive and analyze sensor data anduser commands, generate control signals throughout the system, anddisplay the navigational and localization data, such as the position ofthe instrument within the global coordinate system, anatomical map, etc.

2. Hand Manipulated Input Devices for Robotic Systems

Embodiments of the disclosure relate to systems and techniques for inputdevices for operating robotic medical systems and/or one or more medicalinstruments with such robotic medical systems.

Robotic medical systems, such as the systems described above, caninclude an input device that is configured to allow an operator (e.g., aphysician performing a robotically-enabled medical procedure) tomanipulate and control one or more instruments. In some embodiments, therobotic medical system can include an input device for operating one ormore medical tools. In some examples, the input device can operate oneor more medical tools remotely, such as via teleoperation ortelesurgery.

One skilled in the art will appreciate that the input devices describedherein can be applied in non-medical contexts as well. For example, theinput devices can be useful for manipulating tools that involvehazardous substances. In addition, in some embodiments, the inputdevices described herein can be useful in grabbing objects in bothphysical and virtual environments. In some configurations, the inputdevices can be self-sufficient as service robots interacting with humanoperators. In some configurations, the input device can be coupled(e.g., communicatively, electronically, electrically, wirelessly and/ormechanically) with a medical instrument such that manipulation of theinput device causes a corresponding manipulation of the medicalinstrument. In some configurations, the input device and the medicalinstrument are arranged in a master-slave pair. In some configurations,the input device can be configured to control operation of a roboticsurgical tool. In some configurations, the input device can be referredto as a manipulator, emulator, master, controller, interface, etc.

The input device can serve as an input for an operator to control theactions of a medical instrument, such as in an endoscopic, endoluminal,laparoscopic, or open surgery. Movement of the input device by theoperator can direct the movement of the medical instrument. For example,when an operator translates the input device in three-dimensional space(e.g., up, down, left, right, backwards, and/or forwards), the systemcan cause a corresponding translation of the medical instrument.Similarly, if the operator rotates the input device (e.g., around any ofthree orthogonal axes) the system can cause a corresponding rotationalmovement of the medical instrument. The input device can also includeone or more inputs that allow the operator to actuate the medicalinstrument. As one example, if the medical instrument includes a grasperinstrument, the input device can include one or more inputs that allowthe operator to open and close the grasper instrument.

In some embodiments, robotic medical systems include input devices withseven degrees of freedom that follow the operator’s hand movement, withthe seven degrees of freedom including three positional degrees offreedom (e.g., translational movement in x, y, z space), threerotational degrees of freedom (e.g., rotational movement around pitch,roll, and yaw axes), and one (or more) instrument actuation degree offreedom (e.g., an angular degree of freedom). In some embodiments, theinstrument actuation degree of freedom can control the opening andclosing of an end effector of the medical instrument, such as a gripperor grasper instrument to hold an object. In some embodiments, inputdevices can include greater or fewer numbers of degrees of freedom. Forexample, in some embodiments, the input device can include more thanthree positional degrees of freedom or more than three rotationaldegrees of freedom to provide one or more redundant degrees of freedom.In some embodiments, redundant degrees of freedom can provide additionalmechanical flexibility for the input device, for example, to avoidsingularities caused by the mechanical structure of the input device.

FIG. 19 shows an embodiment of an input device or controller 182 thatcan be used by a user to control one or more instruments. As notedabove, the controller can include two handles 184 that can be used tocontrol instrumentation. Each of the handles 184 can be connected to agimbal 186. Both of the handles 184 can serve as a grasper.

The grasper can be the portion of the input device that the operator(e.g., a physician, a user, etc.) touches and holds to allow theoperator to control the components of the robotic system, such as themedical instruments. The grasper can be the operator’s primary inputinto the system during surgery.

A. Multi-Link Grasper

FIGS. 21A-21B illustrate an embodiment of a handle or grasper 200 thatcan be used as part of a input system such as the input system describedabove with reference to FIG. 19 . FIG. 21A illustrates the grasper 200in an open configuration, while FIG. 21B illustrates the grasper 200 ina closed configuration. FIG. 22 illustrates the grasper of FIGS. 21A-21Bin an exploded view. The grasper 200 can include a plurality of linksand in the illustrated embodiment the grasper 200 includes four links202, 204, 206, 208. In some configurations, the grasper can include atleast two links. In some configurations, the grasper 200 can include atleast three links. In some examples, the grasper 200 can have any numberof links, such as anywhere between 2-12 links. In some embodiments, theplurality of links can be arranged circumferentially around the grasper200. In some configurations, the plurality of links can be equallyspaced from one another. In some configurations, the plurality of linkscan be spaced less than 180 degrees from one another about a centralaxis. Although the configurations described below include four links,any number of links can be included.

As illustrated in FIGS. 21A-21B, the grasper 200 includes four linkscomprising a first link 202, a second link 204, a third link 206, and afourth link 208. The four links 202, 204, 206, 208 can be spaced aboutthe circumference of the grasper 200. The four links 202, 204, 206, 208can be spaced evenly from each other. The four links can be arrangedradially symmetrically. In some embodiments, the four links 202, 204,206, 208 can each be spaced less than 180 degrees from the adjacentlinks. The four links 202, 204, 206, 208 may be each spacedapproximately 90 degrees from one another as shown in the illustratedarrangement. The plurality of links 202, 204, 206, 208 can be arrangedcircumferentially about the grasper 200 as illustrated.

The links 202, 204, 206, 208 can be arranged in pairs. For example, thegrasper 200 can include a first pair of opposing links 202, 204 and asecond pair of opposing links 206, 208. In the illustrated arrangement,the first pair of opposing links can include the first link 202 and thesecond link 204 spaced approximately 180 degrees from one another. Inthe illustrated arrangement, the second pair of opposing links caninclude the third link 206 and the fourth link 208 spaced approximately180 degrees from one another. In modified arrangements, the links 202,204 of the first pair of opposing links can be spaced less than 180degrees from each the links 206, 208 of the second pair of opposinglinks.

With reference to FIG. 22 , the grasper 200 can include a central shaft250. The central shaft 250 can be called a longitudinal shaft,longitudinal member, central member, shaft, or member. The central shaftcan include a circuit 300, such as a printed circuit board, to connectto other components of the grasper 200 or other components of therobotic system. In the illustrated arrangement, the circuit 300 can beplaced inside the central shaft 250.

The central shaft 250 can support the plurality of links 202, 204, 206,208. Each of the first pair of opposing links 202, 204 and each of thesecond pair of opposing links 206, 208 can be coupled to the centralshaft 250. The first link 202 can have a proximal end 232 and a distalend 222. The second link 204 can have a proximal end 234 and a distalend 224. The third link 206 can have a proximal end 236 and a distal end226. The fourth link 208 can have a proximal end 238 and a distal end228. The plurality of links 202, 204, 206, 208 can be connected oroperatively connected at their respective proximal ends 232, 234, 236,238 and/or at their respective distal ends 222, 224, 226, 228.

The first pair of opposing links 202, 204 can each include a finger gripor pad 212, 214. The second pair of opposing links 206, 208 can eachinclude a secondary input 216, 218. Each of the plurality of links 202,204, 206, 208, can include a secondary link 242, 244, 246, 248 to attachthe proximal ends 232, 234, 236, 238 of the links 202, 204, 206, 208 tothe central shaft 250.

Each of the plurality of links can be configured to move from an openposition where proximal ends 232, 234, 236, 238 of each of the pluralityof links 202, 204, 206, 208 are positioned radially away from thecentral shaft 250 to a closed position where the proximal ends 232, 234,236, 238 of each of the plurality of links 202, 204, 206, 208 arepositioned radially close to the central shaft 250. With reference againto FIG. 21A, the grasper 200 is shown in an open position with theproximal ends 232, 234, 236, 238 of the plurality of links 202, 204,206, 208 positioned away from the central shaft 250 of the grasper 200.Each of the plurality of links 202, 204, 206, 208 can be connected tothe grasper 200 at each of its respective distal ends 222, 224, 226,228, such that each link can extend or pivot at an angle away from acentral shaft 250. The proximal ends 232, 234, 236, 238 of each of thefirst pair of opposing links 202, 204 and each of the second pair ofopposing links 206, 208 are configured to radially move relative to thecentral shaft 250.

With reference again to FIG. 21B, the grasper 200 is shown in a closedposition with the proximal ends 232, 234, 236, 238 of the plurality oflinks 202, 204, 206, 208 positioned close to the central shaft 250 ofthe grasper 200. In the closed position, each of the proximal ends 232,234, 236, 238 can be positioned close to the central shaft 250, suchthat the each of plurality of links 202, 204, 206, 208 can be parallelin length to the central shaft 250.

Each of the plurality of links 202, 204, 206, 208 can be biased in anopen position. In some configurations, each link can be spring-loaded inan open position. In some configurations, there are at least two springs(not shown) for each link with a first spring providing the majority ofthe force to bias the link in an open position. A second spring canprovide a slight haptic feedback when the link reaches a certain degreeof closure to indicates to the user when the grasper is closed and thatfurther motion to close the grasper will result in an increase ofclamping force of the surgical instrument.

For example, the first pair of opposing links 202, 204 and/or the secondpair of opposing links 206, 208 can be maneuvered in a pinching motion,which can be translated to movement of the surgical instrument insidethe body. For example, opening and closing the first pair of opposinglinks 202, 204 would correspond to opening and closing of a scissor toolor jaws of a medical instrument. The facilitated pinching motion canmake grasper actuation natural and easy for the user.

The plurality of links 202, 204, 206, 208 on the grasper 200 can measurethe input angle of the user’s fingers. For example, the angle at whichany one or more of the plurality of links 202, 204, 206, 208 arepositioned relative to the central shaft 250 can be translated to thedesired angle of a component of the instrument, such as one or more jawsof an end effector of the instrument.

The grasper 200 can have an increased number of links (such as fourlinks as shown in FIGS. 21A-21B and 22 ) and/or links that arepositioned closer to each other. The grasper 200 can also be radiallysymmetrical, in particular at the most distal end.

By having such a radially symmetric configuration of the grasper, a usercan advantageously be capable of performing certain movements with ease(e.g., a roll maneuver) that would otherwise be challenging. If a userwants to do a roll-intensive task (e.g., suturing) with agrasper unlikethose described herein, the user can only rotate the grasperapproximately 180 degrees before their wrist runs out of range of motionwithout repositioning the user’s hand. To continue rolling the grasper,they have to release their current position of the grasper, rotate theirwrist and regrip the grasper to continue.

The radially symmetric grasper with the plurality of links spaced lessthan 180 degrees from each other allows the physician to roll thegrasper between their finger-tips while maintaining the desiredorientation of the grasper (such as in the closed position or inmaintaining the closure angle). This is possible since the user’sfingers always make contact with at least two links because of theincreased number of plurality of links and reduction of the dead zonesthat can exist between the plurality of links.

Some users may choose to work outside of the finger pads 212, 214, tohold the plurality of links 202, 204, 206, 208 closer to their distalends 222, 224, 226, 228 of the plurality of links 202, 24, 206, 208. Thegrasper 200 advantageously is able to accommodate this and allow forcomfortable use both in and out of the finger pads 212, 214.Additionally, when working outside of the finger pads 212, 214 (such asat the distal ends 222, 224, 226, 228 of one or more of the plurality oflinks 202, 204, 206, 208), the grasper 200 can have radial symmetry,such that the physician can close the grasper 200 (such as closing thefirst pair of opposing links 202, 204 and/or closing the second pair ofopposing links 206, 208) and then roll the grasper 200 between theirfingers. When executing this roll maneuver of the grasper 200, it can bedesirable to have the grasper 200 remain in the closed position. Thefirst pair of opposing links 202, 204 and/or the second pair of opposinglinks 206, 208 can be identical and symmetrical at their distal ends222, 224, 226, 228, allowing the user to use any of the plurality oflinks 202, 204, 206, 208 to close the grasper 200.

The radial symmetry at the distal end can advantageously be moreforgiving of misalignment of the user’s hand when operating the grasper200. Furthermore, the increased number of links being spaced closelytogether (such as, less than 180 degrees from one another) allows theuser to more easily position their fingers to maintain contact with oneor more of the plurality of links as they maneuver the grasper 200. Forexample, when working outside the finger pads 2 12, 2 14, the user canuse any combination of the plurality of links to actuate the grasper200. The plurality of links can increase the number of points ofcontacts for a user to actuate the grasper 200. This can allow the userto maintain contact with the actuators of the grasper more easily, todecrease difficultly of positioning and readjusting of the user’s hand.The plurality of links and radial symmetry can give a user more freedomto manipulate the grasper 200.

The first pair of opposing links 202, 204 can be longer in length thanthe second pair of opposing links 206, 208. The plurality of links canbe arranged such that the longer links 202, 204 oppose each other, withthe shorter links 206, 208 located between the two. The two longer links202, 204 can serve as the main grasping links. The longer links 202, 204can have finger grips, pads, loops such as the finger pads 212, 214 ofthe illustrated arrangement.

In other examples, the first pair of opposing links 202, 204 and thesecond pair of opposing links 206, 208 can be of equal length. In otherexamples, the second pair of opposing links 206, 208 can be longer inlength than the first pair of opposing links 202, 204.

FIG. 23 illustrates the grasper of FIGS. 21A-21B and 22 without theplurality of links, to show the central support shaft 250 and a slidingsupport 260 in more detail. The main support shaft 250 can serve as abearing surface for the sliding support 260. The slide or a slidingsupport 260 can be connect to the plurality of links 202, 204, 206, 208as shown in FIG. 24A. The main support shaft 250 can engage with orconnect to the sliding support 260 to constrain of links 202, 204, 206,208 relative to the central support shaft 250 while still allowingtranslation of the rotation of the plurality of links 202, 204, 206, 208relative to the central support shaft 250. For example, the centralsupport shaft 250 can have slots or recesses to receive portions of thesliding support 260 or receive keys that connect to the sliding support260. Additionally, the keys can serve as stops to limit the translationof the sliding support 260. In some examples, the limit of translationcan be approximately 5 mm.

FIGS. 24A and 24B illustrate the grasper without the second pair oflinks 206, 208 for clarity. FIG. 24A illustrates the grasper with thefirst pair of links 202, 204 in the open position. FIG. 24B illustratesthe grasper with the first pair of links 202, 204 in the closedposition. As illustrated, the first pair of links 202, 204 can beconnected at their respective proximal ends 232, 234 to the slidingsupport 260. For example, each of the plurality of links 202, 204, 206,208 can be connected to the sliding support 260 with secondary links242, 244, respectively. The secondary links 242, 244, can be free topivot to change an angular displacement of the respective link 202, 204into an axial translation of the sliding support 260 along the centralshaft 250. In the open position as shown in FIG. 24A, the slidingsupport 260 can be positioned towards the proximal end of the grasper200, such that the secondary links 242, 246 and the first pair of links202, 204 are each angled away from the central shaft 250. As the slidingsupport 260 is moved in a distal direction, the secondary links 242, 244are angled farther away from the central shaft 250, which in turn movesthe proximal ends 232, 234, 236, 238 away from the central shaft 250. Inthe closed position as shown in FIG. 24B, the sliding support 260 can bepositioned more proximally along the central shaft 250, such that thefirst pair of links 202, 204 and the secondary links 242, 248 areextended and angularly positioned closer to the central shaft 250. Inthe open position, the sliding support 260 can be positioned such thatthe first pair of links 202, 204 and/or the secondary links 242, 244 arefully extended in length and substantially parallel to the centralsupport 250. In this configuration, axial displacement in one of thelinks 202, 204 causes the same displacement in the other link 202, 204.In this configuration, the motion of the first pair of links 202, 204are constrained together. Each of the first pair of opposing links 202,204 can be configured to move together, such that proximal ends 232, 234of the first pair of opposing links 202, 204 are positioned equallydistant from the central shaft 250.

In some of the configurations, the first pair of opposing links 202, 204are configured to move together. In some configurations, the second pairof opposing links 206, 208 are configured to move together. In some ofthe configurations, the first pair of opposing links 202, 204 and thesecond pair of opposing links 206, 208 are configured to move together.In some of the configurations, the first pair of opposing links 202, 204and the second pair of opposing links 206, 208 are configured to moveindependently. In some configurations, each of the plurality of links isconfigured to move independently. In some configurations, each of theplurality of links is configured to move together.

Although not shown in FIGS. 24A-24B for clarity, the second pair oflinks 206, 208 can similarly be connected at their respective proximalends 236, 238 can be connected to the sliding support 260 with secondarylinks 246, 248, respectively. In the illustrated arrangement, all fourlinks 202, 204, 206, 208 can be connected to the same sliding support260. In this configuration, axial displacement in one of the pluralityof links 202, 204, 206, 208 causes the same displacement in theremaining three of the plurality of links 202, 204, 206, 208. In thisconfiguration, the motion of the plurality of links 202, 204, 206, 208are constrained together.

The grasper 200 can include a proximal plate 262. The proximal plate 262can be attached to or integral with the central support shaft 250. Theproximal plate 262 can be positioned about the central support shaft 250towards the proximal end of the central support shaft 250. The proximalplate 262 can act as a stop to limit axial translation of the slidingsupport 260. In some examples, the proximal plate 262 can be positionedto prevent the sliding support 260 from extending the plurality of links202, 204, 206, 208 past the lengths of the plurality of links 202, 204,206, 208 and/or the secondary links 242, 244, 246, 248. In someexamples, the proximal plate 262 can also serve as an additional surfaceto support the user’s hand.

The plurality of links 202, 204, 206, 208 can be connected oroperatively connected at their respective distal ends 222, 224, 226,228. For example, the plurality of links 202, 204, 206, 208 can beconnected or operatively connected at their respective distal ends 222,224, 226, 228 to the distal link support 270. The plurality of links202, 204, 206, 208 can be connected or operatively connected at theirrespective proximal ends 232, 234, 236, 238.

FIG. 25A illustrates a top view of a first link 202 with a finger pad212. FIG. 25B illustrates a bottom view of the first link 202 with thefinger pad 212 of FIG. 25A. Although only the first link 202 of thefirst pair of links 202, 204 is shown in FIGS. 25A-25B, the second link204 and figure pad 214 can be substantially similar. The first pair ofopposing links 202, 204 can each include a finger pad 212, 214,respectively. The finger pads 212, 214 can facilitate manipulation ofthe finger links 202, 204 by increasing the surface area by which theuser can contact and maneuver the opposing links. The finger pads 212,214 can be attached to the respective links 202, 204 by bolts. A Velcroloop (not shown) can be positioned between the finger pads 212, 214 andthe respective links 202, 204 to secure around a user’s finger when inuse.

The first pair of links 202, 204 can each include a distal ridge 223,243 located at the distal ends 222, 224 of the first pair of links 202,204, The distal ridges 223, 243 can each follow the contour of therespective link 202, 204. The distal ridges 223, 243 can be ergonomicfeatures that allows the physician to easily grip and maneuver thegrasper 200 at the distal end. For example, the distal ridges 223, 243can act as a surface to enable a user to pull the grasper 200 towardsthem when working outside the finger pads 212, 214.

The first pair of links 202, 204 can each include a magnet 302, 304 usedto sense the position of the respective pair of links 202, 204. As shownin FIG. 25B, a magnet 302 can be positioned or mounted on the bottom ofthe link 202. Angular displacements of the link 202 can be sensed by ahall effect sensor. The hall effect sensor can be positioned on or inthe central shaft 250. The hall effect sensor can be used to measure themagnitude or changes in the magnetic field. As the plurality of linkschanges angles, the one or more sensors can be used to detect the changein magnetic field due to the motion of the magnets 302, 304, whichoccurs through motion of the respective links 202, 204. In someconfigurations, the hall effect sensor can be used to detect thedistance of the magnet 302, 304 and thus the links 202, 204 with respectto the central shaft 250, which can be used by the input device totransmit control signals. Similarly, the second pair of links 206, 208can also each include a magnet. Additionally, other sensors can be used,such as resistance sensors and/or optical sensors.

As described above, as the user maneuvers the plurality of links of thegrasper, the user’s fingers can adjust the angle of the plurality oflinks. The plurality of links can be oriented or angled relative to thecentral axis or central shaft. The plurality of links on the grasper canmeasure the input angle of the user’s fingers. For example, the angle atwhich any one or more of the plurality of links are positioned relativeto the central shaft can be translated to the desired angle of acomponent of the instrument, such as one or more jaws of an end effectorof the instrument. The grasper 200 can include one or more sensors tomeasure the angle of the plurality of links and thus the input angle ofthe user’s fingers. Also described above, the secondary input state canalso be measured by one or more sensors.

The grasper can include one or more sensors in various locations. Insome configurations, one or more sensors can be located in or coupled toone or more of the plurality of links. In some configurations, one ormore sensors can be located in or coupled to the central shaft. The oneor more sensors in the central shaft can be advantageous in that thereis limited space on each of the plurality of links. The one or moresensors in the central shaft can also advantageously position the sensoraway from motion of the links and from contact by the user, which canreduce risk of damaging the sensor.

In some configurations, the one or more sensors can include a halleffect sensor, such as a 3D hall effect sensor. The one or more sensorscan include 3 different sensors in orthogonal orientations to eachother. Using these sensor readings, an algorithm can be developed todetermine both the angle of the plurality of links and detect asecondary input state. The position of the one or more sensors in thecentral shaft can also advantageously remove the need to run wires andpackage sensors on the links.

The one or more sensors can detect one or more magnets included in theplurality of link and/or one or more magnets in a secondary input. Forexample, each link can include one or more magnets in fixed locations.As the plurality of links changes angles, the one or more sensors can beused to detect the change in magnetic field due to the motion of thesemagnets.

Similarly, the secondary input can include or be operatively connectedto one or more magnets, such that change or movement in the secondaryinput can change the position or orientation of the one or more magnets,which can be detected by the sensor. In some examples, the change of themagnetic field due to the secondary input can be coupled with the motionof the grasper or with one or more components of the grasper. In someexamples, the angle of the plurality of links can be decoupled from thesecondary input state.

In some configurations, the one or more sensors can be a 3degrees-of-freedom sensor with physical electrical connections to theplurality of links and secondary inputs.

In some instances, the input device (e.g., the grasper) may not alwaysbe under the control of the operator. In addition, the input device mayreceive an input that is not intended by the user (e.g., unintendedmotion), which may be caused by the user or some other personnel in theoperating room applying a disturbance to the input device or fromgravity compensation errors (e.g., a user overcompensating for thegravity). In these instances, there may be a need to modifyteleoperation and suppress or reduce movement of the robotic arms andits associated instruments. By detecting the unintended motion, therobotic system can respond to the user input to modify teleoperation andreduce, suppress, or stop movement of the robotic arms and associatedinstruments.

B. Capacitive Sensors

FIGS. 29A and 29B illustrate a sensor at the grasper 200 of FIG. 21A forsensing a user presence in accordance with some embodiments.

As shown in FIG. 29A, the grasper 200 includes one or more sensors 310that are configured to generate a signal in response to a user being inproximity to the sensor. In some embodiments, a first sensor of the oneor more sensors 310 is embedded in the finger pad 212. In someembodiments, the one or more sensors 310 include a second sensor that isembedded in the finger pad 214. In some embodiments, the grasper 200also includes a finger pad 211 that is part of opposing link 206 and afinger pad 213 that is part of opposing link 208. The finger pad 213 mayinclude a third sensor of the one or more sensors 310, and the fingerpad 213 may include a fourth sensor of the one or more sensors 310.

In some embodiments, as shown in FIG. 29B, a sensor of the one or moresensors 310 includes one or more electrodes 311 (e.g., a metallicelectrode and/or a conductive electrode). In some embodiments, the oneor more electrodes 311 are connected to an integrated circuit (e.g.,integrated circuit 328 shown in FIG. 34A). The integrated circuit isconfigured to measure a capacitance that changes when a user’s body part(such as a user’s hand, finger, or palm) is in proximity to the one ormore electrodes. In some embodiments, the sensor includes the integratedcircuit. In some embodiments, the integrated circuit is separate fromthe sensor (although the integrated circuit is electrically connected tothe sensor).

In some embodiments, at least one sensor (e.g., sensor 310) of the oneor more sensors 310 includes one electrode 311 (only), and theintegrated circuit includes circuit 300 for measuring a self-capacitanceof the electrode 311 (e.g., the capacitance between the electrode 311and the earth), as shown in FIG. 30A. The self-capacitance changes whena user’s body part is in proximity to the electrode 311. In someembodiments, the circuit 300 includes an excitation signal source 392(e.g., an oscillator or an alternating current source) and ananalog-to-digital converter 394 coupled to the (same) electrode 311 viaa multiplexer 306.

In some embodiments, at least one sensor (e.g., sensor 310) of the oneor more sensors 310 includes two or more electrodes 311-1 and 311-2, andthe integrated circuit includes circuit 301 for measuring amutual-capacitance between the two electrodes 311-1. and 311-2, asillustrated in FIGS. 30B and 30C. As shown in FIGS. 30B and 30C, themutual-capacitance changes when a user’s body part is in proximity tothe electrode 311-1 or 311-2, or between the two electrodes 311-1 and311-2. In some embodiments, the circuit 301 includes the excitationsignal source 392 (e.g., an oscillator or an alternating current source)coupled to a first electrode of the two or more electrodes (e.g., theelectrode 311-1) and the analog-to-digital converter 394 coupled to asecond electrode of the two or more electrodes (e.g., the electrode311-2) that is distinct from the first electrode.

FIG. 30D illustrates that, in some configurations, a sensor may detect achange in capacitance due to placement of a user’s body part inproximity to components 314 (e.g., a metallic component) locatedadjacently to one or more electrodes 311 of the sensor. In addition,since the links 202, 204, 206, and 208 of grasper 200 are movable withrespect to a the central support 250 of the grasper 200, the distancebetween the one or more electrodes 311 of a sensor 310 and othercomponents 314 of the grasper 200, such as the central support 250 andother components disposed on the central support, may change duringoperation of the grasper 200. Thus, even when the user’s body part isnot in proximity to the one or more electrodes 311, the capacitance canchange, which can be interpreted incorrectly to indicate that the user’sbody part is in proximity to the one or more electrodes 311.

FIG. 30E illustrates that, in some embodiments, at least one sensor(e.g., sensor 310) of the one or more sensors 310 includes an electrodelayer that includes the one or more electrodes 311, and a shield layer312 for reducing capacitance between the one or more electrodes 311 andcomponents 314 of the grasper 200. The shield layer 312 of the sensor310 is disposed between the one or more electrodes 311 of the sensor 310and other components 314 of the grasper 200. This reduces (and ideally,eliminates) changes in the measured capacitance due to a change inposition of the one or more electrodes 311 of the sensor 310 relative toa position of the other components 314 of the grasper 200. Thus, theshield layer 312 reduces the effect that the other components 314 of thegrasper 200 can have on the capacitance measured by the sensor with theone or more electrodes 311.

FIG. 3 1 illustrates an example of the sensor 310 shown in FIGS. 29A and29B that includes an electrode layer 311 and a shield layer 312. In thisexample, the sensor 310 includes the electrode layer 309 and the shieldlayer 312. The electrode layer 309 includes a first electrode 311-1 thatis surrounded by a second electrode 311-2. In some embodiments, theelectrodes 311-1 and 311-2 are insulated from the shield layer 312(e.g., the shield layer 312 may include a conductive material and theelectrodes 311-1 and 311-2 are insulated from the shield layer 312 toreduce (and ideally, prevent or eliminate) any conductive effectsbetween the electrodes 311 and the shield layer 312). In someembodiments, the sensor 310 is positioned in the grasper 200 with theshield layer 312 facing toward inward (e.g., toward the central support250 of the grasper 200) and the electrode layer 309 facing outward(e.g., away from the central support 250 of the grasper 200).

In some embodiments, the sensor 310 includes an extension 313, which isused for electrically connecting the sensor 310 to an integrated circuit(e.g., the integrated circuit 328).

In some embodiments, the sensor 310 is made flexible (e.g., the sensor310 is made of a flexible material). For example, the sensor 310includes a multi-layer flex circuit. In some embodiments, the flexcircuit is embedded in the finger pad (e.g., FIG. 29A). In someembodiments, the flex circuit is formed, molded, or machined into thefinger pad. For example, in some embodiments, the flex circuit isinjection molded in the finger pad. In some embodiments, the entiresensor 310 is made flexible. In some embodiments, only a portion of thesensor 310 is made flexible (e.g., a first portion of the sensor 310 isrigid while a second portion of the sensor 310 is flexible). Forexample, in some embodiments, the extension 313 is flexible, while therest of the sensor 310 (called herein a sensing portion) is rigid.

FIGS. 32A and 32B illustrate examples of electrode configurations forthe sensor shown in FIG. 29A. FIG. 32A illustrates an electrodeconfiguration 311-A that includes a first electrode 311-1 that isinterleaved with a second electrode 311-2. In some implementations, theelectrode configuration 311-A provides consistent sensitivity across itssurface area. FIG. 32B illustrates another electrode configuration 311-Bthat includes the first electrode 311-1 being disposed side-by-side tothe second electrode 311-2. In some implementations, the electrodeconfiguration 311-B provides electrodes with large surface areas,thereby providing high sensitivity.

FIG. 33 illustrates an example measurement for sensing a user presenceusing the sensor shown in FIGS. 29A and 29B. FIG. 33 illustrates anexample graph showing a signal 318 corresponding to a measuredcapacitance between two electrodes 311-1 and 311-2 of a sensor 310 overtime in response to a user’s body part changing its distance to theelectrodes 311-1 and 311-2. As shown, the signal 318 increases from abaseline value 316 (e.g., a background capacitance value when a user’sbody part is not proximate to the electrodes 311-1 and 311-2) inresponse to a user’s body part approaching the electrodes 311-1 and311-2 of the sensor 310. The signal 318 increases above a detectionthreshold value 322 until it reaches a maximum capacitance value 324.The detection threshold value 322 corresponds a capacitance value abovewhich a user presence is deemed to be present. In some embodiments, thedetection threshold value 322 is selected in a way so that thedifference between the detection threshold value 322 and the baselinevalue 316 is greater than a representative value of noise 320 (e.g., 3,4, 5, 6, 7, 8, 9, or 10 times greater than a root-mean-squared amplitudeof the noise 320 detected by the electrodes 311-1 and 311-2).

In some embodiments, the signal 318 is processed (e.g., by theintegrated circuit 328) before determining the user presence. Forexample, the signal 318 is filtered to remove or reduce the noise 320(e.g., based on the rate of change by using, for example, a frequencydomain filter, such as a Fourier filter or a derivative integralfilter).

FIG. 34A illustrates coupling of the sensor shown in FIGS. 29A and 29Bto an integrated circuit 328 for sensing a user presence. The sensorincludes a flexible connector 330 (corresponding to the extension 313)for electrical connection to the integrated circuit. This allows therelative movement (e.g., a rotational movement) of the sensing portionof the sensor to the integrated circuit 328 while maintaining theelectrical contact between the sensing portion of the sensor to theintegrated circuit 328, which may be located at the tip of the grasper200.

In some embodiments, each finger pad of the grasper 200 includes asensor and the sensor of each finger pad is electrically coupled to theintegrated circuit 328 through the flexible connector 330. For example,when the grasper 200 includes four finger pads (and hence at least foursensors), the integrated circuit 328 is electrically coupled to the foursensors via four flexible connectors 330 (e.g., one flexible connector330 for each sensor). FIG. 34B illustrates four flexible connectors 330electrically coupling the four sensors embedded in the four finger pads211 through 214 to the integrated circuit 328.

C. Optical Sensors

FIGS. 35A and 35B illustrate examples of light curtain configurationsgenerated by optical sensors located at the input device of FIG. 21A forsensing a user presence.

In FIG. 35A, the grasper 200, mounted on a gimbal 332, is coupled withone or more optical sensors 334 (e.g., optical sensors 334-1 through334-3). The one or more optical sensors 334 detect optical signals froma user’s body part to determine the user presence. In some embodiments,the one or more optical sensors 334 are coupled with, or include, alight source for providing illumination light and the one or moreoptical sensors detect light that has been reflected or scattered by theuser’s body part, such as finger(s). In some embodiments, each of theone or more optical sensors 334-1 through 334-3 is coupled with, orincludes, a light source for providing light curtains 336-1 through33-6, respectively. In some embodiments, the one or more optical sensors334 include a time-of-flight sensor for determining a distance from thetime-of-flight sensor to an object (e.g., the user’s body part) thatcomes into a corresponding light curtain. In some embodiments, each ofthe one or more optical sensors 334 is a time-of-flight sensor. In someembodiments, the one or more optical sensors 334 include other types ofoptical sensors (e.g., beam break sensors, LIDAR, cameras, etc.). Insome embodiments, the one or more optical sensors 334 are amountedadjacent to one end of the grasper 200 toward the gimbal 332 toward tothe opposite end of the grasper 200, as shown in FIG. 35A. Thisconfiguration allows placing the one or more optical sensors 334 so thatfingers are placed within the field of view of the one or more opticalsensors 334.

In FIG. 35B, at least a subset of the one or more optical sensors 334(e.g., the optical sensors 334-1 and 334-2) is mounted on the gimbal 332facing toward the grasper 200 (e.g., the one end of the grasper 200 thatis not directly coupled to the gimbal 332). In some embodiments, theoptical sensors 334-1 and 334-2 are placed to avoid occlusion by thefinger pads. In some embodiments, the one or more optical sensors 334also include at least one optical sensor 334-3 mounted on the one end ofthe grasper 200 (facing away from the opposite end of the grasper 200coupled to the gimbal 332). This optical sensor may be used to detect apresence of a user’s palm, which can provide additional information fordetermining the user presence.

Although FIGS. 35A and 35B show three optical sensors, in someembodiments, additional or fewer optical sensors may be used (e.g., 1,2, 4, 5, 6, 7, 8, 9, 10, or more optical sensors).

In addition, although FIGS. 35A and 35B are used to describe placementof optical sensors, other types of sensors (e.g., ultrasonic sensors,radar, sonar, pressure sensors, etc.) may be used instead of, or inaddition to, the optical sensors.

FIGS. 36A and 36B illustrate examples of finger loops for use inconjunction with optical sensors at the input device of FIG. 21A. FIG.36A shows finger loops 338-1 and 338-2 (with open ends) and FIG. 36Bshows finger loops 340-1 and 340-2 (with closed ends, in which case thefinger loops may be called finger cups). The finger loops 338 provide asecure connection between the user and the grasper. In some embodiments,the integrated circuit 328 is configured to distinguish the finger loopsfrom the user’s body parts (e.g., using threshold windows todifferentiate signals from the user’s body parts and signals from thefinger loops). In some implementations, the wall of the finger cups 340facilitate distinguishing the user’s body parts from the finger cups340.

As described herein, the sensors (e.g., capacitance sensors, opticalsensors, etc.) are used to determine the user presence, which can beused to reduce or eliminate unintended movements of the robotic arms orsurgical tools. It is also helpful to determine the user control evenwhen the user contact is not detected on the grasper 200. For example,when the user uses the finger loops or finger cups (shown in FIGS. 36Aand 36B) to control the grasper (e.g., during the opening of the grasper200), the user is still in control of the grasper 200, although the usermay not be in contact with (or in proximity to) the sensors within thefinger pads as the fingers are lifted away from the finger pads.

D. Enhanced Determination of User Presence or Absence

In some embodiments, user control is determined by combining,information from the one or more sensors described above (e.g.,capacitance sensors and/or optical sensors) with additional information(also called herein secondary information). In some embodiments, themovement of the robotic arms or surgical tools is controlled based onthe information from the one or more sensors (e.g., capacitance sensorsand/or optical sensors) and the secondary information, thereby enhancingoperation of medical robotic systems.

In some embodiments, the additional information includes a grasper angle(e.g., an angle defined by the central axis of the grasper and a link,such as link 202). In some configurations, the grasper is at afully-open angle (e.g., as shown in FIG. 24A) when no external force isapplied (e.g., no user input).Thus, a grasper angle other than, or lessthan, a predefined grasper angle threshold (e.g., the fully-open angle)indicates that the user is in control.

In some embodiments, the additional information includes a velocity ormovement of one or more joints supporting the input device. FIG. 37illustrates robotic joints supporting the input device of FIG. 21A inaccordance with some embodiments. For example, as shown in FIG. 37 , agimbal roll axis 342 extends through a roll joint that is rotatablycoupled with the grasper 200 along the axis of the grasper 200. The rolljoint is designed to have passively zero velocity (e.g., there is nogravity compensation), so there cannot be any gravity compensationerror. As such, it has no movement (and hence, zero velocity) when thereis no user input to the grasper 200 (e.g., when the user is notoperating the grasper 200). Thus, a rotational movement (or a rotationalvelocity) of the rolling joint along the gimbal roll axis 342 indicatesthat the user is in control (e.g., the user is rotating the grasper 200about the gimbal roll axis 342). In another example, a rotational jointextending through a shoulder yaw axis 344 is coupled to the grasper 200.The rotational joint extending through the shoulder yaw axis 344 has nomovement (and hence, zero velocity) when there is no user input to thegrasper 200 (e.g., when the user is not operating the grasper 200).Thus, a rotational movement (or a rotational velocity) of the rotationaljoint extending through the shoulder yaw axis 344 can also indicate thatthe user is in control (e.g., the user is moving the grasper 200 aboutthe shoulder yaw axis 344).

In some embodiments, the additional information includes a time periodor duration from the most recent detection of user presence. Byproviding a time duration as an additional input, the system canadvantageously account for when a user might be present, but temporarilywithdraws his or her hand from the grasper for a short period (e.g.,0.01-0.04 seconds). In such a situation, the system may not want to haltmovement of the robotic arms or surgical tools, as this may causeunnecessary interruptions, despite the presence of the user.Accordingly, in some embodiments, the system can incorporate differenttemporal thresholds to help refine the determination of user presenceand control. For example, a first time threshold can be provided (e.g.,0.05 - 1 second or greater) as a debounce, whereby if a user is notdetected by the system within the first time threshold, movement may bereduced or halted and/or monitored for unintended movement above adistance threshold. A second time threshold (e.g., 60 seconds, 90seconds, 120 seconds, or greater) can be provided as a timeout, wherebyif a user is not detected by the system within the second timethreshold, movement may be automatically halted regardless of thedistance of the unintended movement. Note that the time periods providedabove for the first threshold and the second threshold are exemplary andnot meant to be limiting.

In some embodiments, the additional information includes informationindicating a change in the movement of robotic arms or surgical toolsthat is inconsistent with a user input. Such information can come fromencoders (e.g., position sensors) and/or from derived information basedon changes to velocity, acceleration, jerking, etc. For example, a bumpor impulse in a motion profile of the robotic arms or surgical tools orinformation from mechatronic sensors, such as current, backelectromotive force, torque, or force, could indicate movement of therobotic arms or surgical tools that are different from the movement ofthe robotic arms or surgical tools caused by the user input. In anotherexample, gravity drift is detected based on the information frommechatronic sensors (e.g., an error in gravity compensation may resultin a constant acceleration in a constant direction).

FIG. 38A illustrates a state diagram for the medical robotic system inaccordance with some embodiments. The state diagram includes a(unmodified) teleoperation mode 381, a modified teleoperation mode 382,and a safe mode 383.

In some embodiments, in accordance with a determination that usercontrol is detected, the medical robotic system enters or remains in the(unmodified) teleoperation mode 381. In some embodiments, while themedical robotic system is in the (unmodified) teleoperation mode 381,the medical robotic system moves robotic arms and/or surgicalinstruments in accordance with a user input without any damping (or witha first damping that is less than a second damping provided while themedical robotic system is in the modified teleoperation mode 382).

In some embodiments, in the event that lack of user control is detectedin conjunction with movement of the robotic arms or surgical tools, themedical robotic system can transition into the safe mode 383. While themedical robotic system is in the safe mode 383, teleoperation is haltedor cut off between the input device and the robotic arm or surgicalinstrument. In some embodiments, to avoid unnecessary disruptions, themedical robotic system monitors the movement of the input device, andtransition into the safe mode 383 if the position of the input devicehas changed by an unsafe distance in comparison to when the user waslast detected to be in active control. Additionally or alternatively,the medical robotic system can transition into the safe mode 383 if themotion (velocity, acceleration, etc.) of the input device is consideredunsafe (e.g., the velocity of the input device exceeds a velocitythreshold or the acceleration of the user acceleration exceeds anacceleration threshold) while the user is not detected to be in activecontrol.

In some implementations, the medical robotic system, prior to enteringthe safe mode 383, still modifies control algorithms to decrease thelikelihood of hazardous unintended motion via (i) changing motionscaling so the input device motion results in smaller tool tip motion;(ii) adjusting damping on the input device to increase the load requiredto create input device motion; (iii) command haptic feedback to maintaina current position of the input device; and (iv) saturate commandedvelocity from the input device at a lower value than during normaloperation. For example, any of the foregoing (i) to (iv) can also beprovided while the medical robotic system is in the modifiedteleoperation mode 382. The advantage of (i) to (iv) is that theteleoperation is not interrupted unnecessarily. For example, a situationmay occur where though a user presence/control might not be detected, itmay not be warranted to enter into a safe mode whereby teleoperation ishalted. In such a scenario, the system can, for example, dampen themotion of the input device, instead of immediately halting teleoperationof the system.

Although the system diagram shown in FIG. 38A includes state transitionsbetween the (unmodified) teleoperation mode 381 and the modifiedteleoperation mode 382, state transitions between the modifiedteleoperation mode 382 and the safe mode 383, and state transitionsbetween the (unmodified) teleoperation mode 381 and the safe mode 383,in some implementations, one or more state transitions may be omitted orblocked (e.g., in some implementations, state transitions between themodified teleoperation mode 382 and the safe mode 383 may not beallowed).

Although the system diagram shown in FIG. 38A has three states, in someembodiments, the system diagram may include additional or fewer states(e.g., the system diagram may have only two states, such as the(unmodified) teleoperation mode 381 and the safe mode 383).

FIG. 38B illustrates transitions among different states of a medicalsystem in accordance with some embodiments.

The states illustrated in FIG. 38B include engaged state 370 anddisengaged state 371. In some embodiments, the engaged state 370includes substates, such as “not driving” state 372, which indicatesthat a user is not in control, and driving state 373, which indicatesthat a user is in control. In some embodiments, the driving state 373includes also includes substates, such as “user detected” state 374,which indicates that a user is detected (e.g., using a capacitancesensor) and “user not detected” state 375 (e.g., using a capacitancesensor). Thus, a user may be in control (e.g., the medical system is inthe driving state 373) even though the user is not detected (the “usernot detected” state 375, which is a substate of the driving state 373).In some embodiments, the disengaged state 371 includes substates, suchas “head in” state 376 and “head out” state 377.

In some embodiments, the medical system (378) transitions from the “notdriving” state 372 to the driving state 373 in accordance with adetermination that a gripper is matched. In some embodiments, themedical system unlocks a haptic input device in conjunction withtransitioning from the “not driving” state 372 to the driving state 373.In some embodiments, the medical system (379) transitions from the “userdetected” state 374 to the “user not detected” state 375 in accordancewith a determination that user presence is not detected (e.g., no sensorhas detected user presence, or less than a certain number (e.g., two,three, or four) of sensors have detected user presence and a grasperangle is greater than a first threshold angle (e.g., 30°, 40°, 45°,etc.) and the shoulder yaw axis 344 has a rotational speed below a firstthreshold speed (e.g., less than 0.1 rad/s, 0.2 rad/s, 0.3 rad/s, 0.4rad/s, 0.5 rad/s, 0.6 rad/s, 0.7 rad/s, 0.8 rad/s, 0.9 rad/s, 1 rad/s, 2rad/s, 3 rad/s, 4 rad/s, 5 rad/s, or 10 rad/s, etc.)). In someembodiments, the medical system (384) transitions from the “user notdetected” state 375 to the “user detected” state 374 in accordance witha determination that any sensor has detected user presence. For example,the medical system may transition to the “user detected” state 374 inaccordance with a determination that a certain number of sensors (e.g.,capacitance sensors), such as two or more sensors, have detected userpresence, or a grasper angle is closed (e.g., less than a secondthreshold angle, such as 15°, 10°, 5°, etc.), or the shoulder yaw axis344 has a rotational speed above a second threshold speed (e.g., greaterthan 0.1 rad/s, 0.2 rad/s, 0.3 rad/s, 0.4 rad/s, 0.5 rad/s, 0.6 rad/s,0.7 rad/s, 0.8 rad/s, 0.9 rad/s, 1 rad/s, 2 rad/s, 3 rad/s, 4 rad/s, 5rad/s, or 10 rad/s, etc.).

In some embodiments, the medical system resets a timer (and/or restartsthe timer) in conjunction with transitioning to the “user detected”state 374 (e.g., the timer is used to determine whether the medicalsystem should transition to the “user not detected” state 375). In someembodiments, the medical system, while in the “user detected” state 374,detects user presence (e.g., any sensor has detected user presence), andin response, (385) remains in the “user detected” state 374 and resets atimer (and/or restarts the timer) (e.g., for determining whether themedical system should transition to the “user not detected” state 375).In some embodiments, the medical system, while in the “user detected”state 374, does not detect user presence (e.g., no sensor has detecteduser presence), and in response, (386) remains in the “user detected”state 374 and resets a timer (and/or restarts the timer) (e.g., fordetermining whether the medical system should transition to the “usernot detected” state 375). In some embodiments, the medical system (387)transitions from the “user not detected” state 375 to the “head in”state in accordance with a determination that the timer has elapsed athreshold duration (e.g., 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17,18, 19, 20, 25, 30, 40, 50, or 60 seconds or within an interval betweenany two of the aforementioned values). In some embodiments, the medicalsystem locks the haptic input device (e.g., stops movement of therobotic arm or the surgical tool in response to movement of the hapticinput device) in conjunction with transitioning to the “head in” state.In some embodiments, the medical system (388) transitions from the “usernot detected” state 375 to the “head in” state in accordance with adetermination that a robotic arm or a surgical tool has drifted morethan a distance threshold (e.g., 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15,16, 17, 18, 19, 20, 25, 30, 40, 50, or 60 mm or within an intervalbetween any two of the aforementioned values). In some embodiments, themedical system locks the haptic input device in conjunction withtransitioning to the “head in” state. In some embodiments, the medicalsystem (389) transitions from the disengaged state 371 to the engagedstate 370 in accordance with a determination that any sensor hasdetected user presence. In some embodiments, the medical system resets atimer (and/or restarts the timer) in conjunction with transitioning fromthe “head in” state 376 to the engaged state 370.

In some embodiments, the medical system resets a timer (and/or restartsthe timer) in conjunction with transitioning to the “user not detected”state 375. In some embodiments, the timer can serve as secondaryinformation (e.g., in addition to sensing via capacitance) to helpdetermine when the system can properly transition back to a “userdetected” state 374. For example, in some embodiments, when the systemis in the “user not detected” state 375, it may take a certain amount oftime before the system transitions back to the “user detected” state374, even beyond the initial contact between the user and the graspersand the associated capacitance sensors.

In another embodiment, the secondary information (with or without thesensor information) is used to determine criteria for a statetransition. In some embodiments, the medical system resets a timer(and/or restarts the timer) in conjunction with transitioning to the“user not detected” state 375. In some embodiments, the timer can serveas secondary information (e.g., in addition to sensing via capacitance)to help determine the criteria for when the system can properlytransition back to a “user detected” state 374. For example, in someembodiments, when the system is in the “user not detected” state 375 forlonger than a pre-defined duration (e.g., 1 second), the system mayrequire specific criteria based on the contact sensing and/or secondaryinformation to transition back to “user detected” state 374. Thiscriteria could be different than the criteria to reestablish “userdetection” if the user has not been detected for less than thatduration. For example, the system may require only 1 sensor to indicatepresence if the system was in “user not detected” state 375 for lessthan 1 second, and require at least 2 sensors to indicate presence ifthe system was in “user not detected” state 375 for more than 1 second.Alternatively, the system may allow secondary information such as G6motion to indicate presence if the system was in “user not detected”state 375 for less than 1 second, but require contact sensors toindicate presence if the system was in “user not detected” state 375 formore than 1 second. Providing a timer as secondary information in the“user not detected” state can advantageously help determine whatcriteria from the information warrants the transition back to “userdetected”.

In some embodiments, the medical system resets a timer (and/or restartsthe timer) in conjunction with transitioning to the disengaged state 371(e.g., “head in” state 376). In some embodiments, the timer can serve assecondary information (e.g., in addition to sensing via capacitance) tohelp determine when the system can properly transition back to theengaged state 370 (e.g., the driving state 373, and in particular the“user detected” state 374). For example, in some embodiments, when thesystem is in the disengaged state 371 (e.g., “head in” state 376), itmay take a certain amount of time before the system transitions back tothe engaged state 370 (e.g., the driving state 373, and in particular“user detected” state 374), even beyond the initial contact between theuser and the graspers and the associated capacitance sensors. This isbecause the system may want to account for the initial touch by the userwith the grasper pads prior to actual teleoperated driving. In otherwords, the system may not want to go straight to the driving state 373upon the user’s initial contact with the graspers. Providing a timer assecondary information in the disengaged state 371 can advantageouslyhelp determine whether a user’s contact has been made with the grasperslong enough to warrant actual driving. In some embodiments, the medicalsystem resets the timer (and/or restarts the timer) in response todetecting the user presence (so that a certain period of time (e.g.,0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, or 1 second) after the userpresence has been detected can elapse before allowing the user to drivethe robotic arm).

In some embodiments, the medical system resets a timer (and/or restartsthe timer) in conjunction with transitioning to the disengaged state 371(e.g., “head in ” state 376). In some embodiments, the timer can serveas secondary information (e.g., in addition to sensing via capacitance)to help determine the criteria for when the system can properlytransition back to a the engaged state 370 (e.g., the driving state 373,and in particular the “user detected” state 374). For example, in someembodiments, when the system is in the disengaged state 371 for longerthan a pre-defined duration (e.g., 1 second), the system may requirespecific criteria based on the contact sensing and/or secondaryinformation to transition back to the engaged state 370 (e.g., thedriving state 373, and in particular the “user detected” state 374).This criteria could be different than the criteria to re-establish “userdetection” if the user has not been detected for less than thepre-defined duration. For example, the system may require only 1 sensorto indicate presence if the system was in the disengaged state 371 forless than 1 second, and require at least 2 sensors to indicate presenceif the system was in the disengaged state 371 for more than 1 second.Alternatively, the system may allow secondary information such as arotational movement (or a rotational velocity) of a rotational jointextending through the shoulder yaw axis 344 to indicate user presence ifthe system was in the disengaged state 371 for less than 1 second, butalso require contact sensors to indicate user presence if the system wasin the disengaged state 371 for more than 1 second. Providing a timer assecondary information in the disengaged state 371 can advantageouslyhelp determine what criteria from the information warrants thetransition back to the engaged state 370 (e.g., the driving state 373,and in particular, the “user detected” state 374) and actual driving.

In some embodiments, the secondary information includes an end effectorpose or information indicating a change in the end effector pose. Forexample, in some embodiments, the secondary information includes (i) theend effector pose or the information indicating a change in the endeffector pose, and (ii) a rotational movement (or a rotational velocity)of a rotational joint extending through the shoulder yaw axis 344 sothat the user control is determined based on the change in the endeffector pose and the rotational movement, even when no user contact isdetected (e.g., using a capacitance sensor). In some embodiments, thechange in the end effector pose is used to select the criteria for thestate transition. For example, in accordance with a determination that amovement, of the end effector, that is associated with user control(e.g., continuous or semi-continuous movement of the end effector,movement of the end effector at a speed below a threshold speed,movement of the end effector that includes a change in a direction ofthe end effector) is detected, first criteria (e.g., less stringentcriteria, such as requiring detection of contact by a single sensor) areused for a state transition In accordance with a determination that amovement, of the end effector, that is not associated with user control(e.g., gravity drift or bump), second criteria (e.g., more stringentcriteria, such as requiring detection of contact by multiple sensors)are used for a state transition.

FIGS. 39A and 39B are a flowchart illustrating a method 400 foroperating a surgical tool via the input device of FIG. 21 .

The method 400 includes, while operating a robotic arm in response toinformation from an input device, (4010) receiving first informationfrom a first set of two or more electrodes (e.g., electrodes 311-1 and311-2).

In some embodiments, the method 400 also includes (4020) determining, byan integrated circuit (e.g., integrated circuit 328), a mutualcapacitance between the two or more electrodes of the first set of twoor more electrodes (e.g., the integrated circuit includes circuit 301electrically coupled to the electrode as shown in FIGS. 30B and 30C).The user presence is determined based at least in part on the mutualcapacitance (e.g., a change in the mutual capacitance, above a thresholdvalue, indicates the user presence).

The method 400 also includes (4030) determining a user presence at afirst finger pad based on the first information. The first finger padincludes the first set of two or more electrodes. The method 400 furtherincludes (4040) modifying operation (e.g., teleoperation) of the roboticarm in response to the information from the input device in accordancewith a determination of the user presence at the first finger pad. Insome embodiments, the method 400 further includes modifying operation(e.g., teleoperation) of the robotic arm in response to the informationfrom the input device in accordance with a determination of lack of theuser presence at the first finger pad.

In some embodiments, modifying teleoperation of the robotic arm includes(4042) ceasing movement of the robotic arm in response to theinformation from the input device (e.g., regardless of any inputprovided to the input device the robotic arm may not move).

In some embodiments, modifying teleoperation of the robotic arm includes(4044) reducing a velocity of the robotic arm in response to theinformation from the input device (e.g., the robotic arm moves at afirst velocity before the modification, and the robotic arm moves at asecond velocity less than the first velocity after the modification).

In some embodiments, modifying teleoperation of the robotic arm includes(4046) reducing motion scaling between the input device and the roboticarm. (e.g., reducing an amount of movement of the robotic arm withrespect to an amount of movement of the input device). For example, therobotic arm may move by a first distance in response to movement of aninput device by a particular input distance before the modification andthe robotic arm may move by a second distance less than the firstdistance in response to movement of the input device by the particularinput distance after the modification.

In some embodiments, the method 400 also includes (4050) receivingsecond information from a second set of two or more electrodes, and(4052) determining a user presence at a second finger pad based at leastin part on the second information. The second finger pad includes thesecond set of two or more electrodes.

In some embodiments, the method 400 also includes (4054) receiving thirdinformation from a third set of two or more electrodes, and (4056)determining a user presence at a third finger pad based at least in parton the third information. The third finger pad includes the third set oftwo or more electrodes. The method 400 further includes (4058) receivingfourth information from a fourth set of two or more electrodes, and(4060) determining a user presence at a fourth finger pad based on thefourth information. The fourth finger pad includes the fourth set of twoor more electrodes.

In some embodiments, the method 400 also includes (4070) modifying theoperation of the robotic arm in response to the information from theinput device in accordance with a determination of the user presence atthe second finger pad. In some embodiments, the method 400 also includesmodifying the operation of the robotic arm in response to theinformation from the input device in accordance with a determination oflack of the user presence at the second finger pad. In some embodiments,the method 400 includes modifying the operation of the robotic arm inresponse to the information from the input device in accordance with adetermination of the user presence at the first finger pad and the userpresence at the second finger pad. In some embodiments, the method 400includes modifying the operation of the robotic arm in response to theinformation from the input device in accordance with a determination oflack of the user presence at the first finger pad and lack of the userpresence at the second finger pad. In some embodiments, the method 400includes modifying the operation of the robotic arm in response to theinformation from the input device in accordance with a determination ofthe user presence at the first finger pad, the user presence at thesecond finger pad, and the user presence at the third finger pad. Insome embodiments, the method 400 includes modifying the operation of therobotic arm in response to the information from the input device inaccordance with a determination of the user presence at the first fingerpad, the user presence at the second finger pad, the user presence atthe third finger pad, and the user presence at the fourth finger pad.

In some embodiments, the method 400 is performed by a medical systemthat includes an input device (e.g., the input system 182) forcontrolling (e.g., movement, function) operation (e.g., teleoperation)of a robotic arm. The input device includes a grasper (e.g., the grasper200) that includes a first finger pad. The first finger pad includes afirst set of two or more electrodes (e.g., electrodes 311-1 and 311-2)for determining a user presence at the first finger pad (e.g., userproximity to the first finger pad, or user contact with the first fingerpad). The medical system also includes a processor (e.g., processor(s)280) for modifying operation of the robotic arm in response toinformation (e.g., one or more electrical signals corresponding to auser input) from the input device in accordance with a determination ofthe user presence at the first finger pad (e.g., transition the medicalsystem into a safe mode (e.g., safe mode 383) in accordance with (basedat least in part on) a determination that the user is not present at thefirst finger pad, and transitioning the medical system out of the safemode (e.g., to the teleoperation mode 381) in accordance with (based atleast in part on) a determination that the user is present at the firstfinger pad). In some embodiments, the medical system also includesmemory (e.g., memory 282) storing instructions for execution by theprocessor. The stored instructions include instructions for modifyingthe operation of the robotic arm in response to the information from theinput device in accordance with the determination of the user presenceat the first finger pad.

In some embodiments, the two or more electrodes include a firstelectrode and a second electrode that is interdigitated (e.g., coiled)with the first electrode.

In some embodiments, the two or more electrodes include a firstelectrode and a second electrode that is disposed adjacent to the firstelectrode. In some embodiments, the first electrode and the secondelectrode extend substantially in a same direction.

In some embodiments, the grasper includes a second finger pad distinctand separate from the first finger pad. The second finger pad includes asecond set of two or more electrodes for determining a user presence(e.g., user proximity to the finger pad) at the second finger pad. Theuser presence at the second finger pad is determined independently ofthe user presence at the first finger pad.

In some embodiments, the grasper further includes a third finger pad anda fourth finger pad. In some embodiments, the grasper includesadditional finger pads (e.g., a fifth finger pad, a sixth finger pad,etc.).

In some embodiments, the third finger pad includes a third set of two ormore electrodes for determining a user presence (e.g., user proximity tothe finger pad) at the third finger pad, and the fourth finger padincludes a fourth set of two or more electrodes for determining a userpresence (e.g., user proximity to the finger pad) at the fourth fingerpad. The user presence at the first finger pad, the user presence at thesecond finger pad, the user presence at the third finger pad, and theuser presence at the fourth finger pad are determined independently ofeach other.

In some embodiments, in accordance with a determination of a lack of theuser presence (e.g., user is not proximate to the finger pad or user isnot in contact with any of the finger pads, all of the finger pads, or apredefined number of finger pads), the processor ceases operation (e.g.,teleoperation, movement) of the robotic arm in response to theinformation from the input device. In some embodiments, the memorystores instructions for execution by the processor, the storedinstructions including instructions for, in accordance with thedetermination of the lack of the user presence, ceasing the operation ofthe robotic arm in response to the information from the input device.

In some embodiments, in accordance with a determination of a lack of theuser presence (e.g., user is not proximate to the finger pad or user isnot in contact with any of the finger pads, all of the finger pads, or apredefined number of finger pads), the processor reduces a velocity ofthe robotic arm in response to the information from the input device. Insome embodiments, the memory stores instructions for execution by theprocessor, the stored instructions including instructions for, inaccordance with the determination of the lack of the user presence,reducing the velocity of the robotic arm in response to the informationfrom the input device.

In some embodiments, in accordance with a determination of a lack of theuser presence (e.g., user is not proximate to the finger pad or user isnot in contact with any of the finger pads, all of the finger pads, or apredefined number of finger pads), the processor reduces motion scalingbetween the input device and the robotic arm (e.g., reducing an amountof movement of the robotic arm with respect to an amount of movement ofthe input device). In some embodiments, the memory stores instructionsfor execution by the processor, the stored instructions includinginstructions for, in accordance with the determination of the lack ofthe user presence, reducing the motion scaling between the informationfrom the input device and the movement of the robotic arm.

In some embodiments, the grasper further includes an integrated circuitfor measuring a mutual capacitance between the two or more electrodes ofthe first set of two or more electrodes. The user presence is determinedbased at least in part on the mutual capacitance.

In some embodiments, the grasper includes a static handle that iscoupled to the first finger pad, the first finger pad configured to moverelative to the static handle. The integrated circuit is disposed in thestatic handle.

In some embodiments, the first set of two or more electrodes is embeddedwithin the first finger pad.

In some embodiments, the first set of two or more electrodes includes anelectrode layer comprising the two or more electrodes; and a shieldlayer for reducing capacitance between the two or more electrodes withcomponents of the grasper.

FIG. 40 is a flowchart illustrating a method 410 of operating a medicalsystem for controlling a medical instrument using the input device ofFIG. 21 .

The method 410 includes (4110) receiving, from a sensor coupled to(e.g., embedded in) a grasper of the input device, sensor informationrelated to a user presence at the grasper; (4120) receiving secondaryinformation associated with the grasper (e.g., a configuration of thegrasper, such as grasper angle or velocity, motion of a passivelystationary joint, and/or a time point of last grasper movement orlast-detected user presence); and (4130) determining user control at thegrasper based on the sensor information and the secondary information.As used herein, in some cases, the term “user control” refers to aninput intentionally (or deliberately) provided a user for controllingmovement of a robotic arm, as compared to an input unintentionallyprovided by the user (e.g., due a slip of a finger, slow drift, etc.).

In some embodiments, the secondary information includes a timethreshold. Determining the user presence at the grasper includes (4132)comparing duration over which the sensor information indicates a lack ofthe user presence and the time threshold.

In some embodiments, the secondary information includes informationindicating a change in a configuration (e.g., position and/ororientation) of the input device at a first time and a second time thatis subsequent to the first time (e.g., current time). Determining theuser presence at the grasper includes (4134) comparing the change in theconfiguration of the input device and a configuration change threshold(e.g., a predefined distance and/or angle difference).

In some embodiments, the information indicating the change in theconfiguration of the input device is obtained by determining aconfiguration (e.g., a position and/or orientation) of the input deviceat the first time, determining a configuration of the input device atthe second time, and determining the change in the configuration of theinput device based on the configuration of the input device at the firsttime and the configuration of the input device at the second time.

In some embodiments, the secondary information includes informationindicating a change in a configuration (e.g., position and/ororientation) of the medical instrument at a first time and a second timethat is subsequent to the first time (e.g., current time). Determiningthe user presence at the grasper includes (4136) comparing the change inthe configuration of the medical instrument and a configuration changethreshold (e.g., a predefined distance and/or angle difference).

In some embodiments, the information indicating the change in theconfiguration of the medical instrument is obtained by determining aconfiguration (e.g., a position and/or orientation) of the medicalinstrument at the first time, determining a configuration of the medicalinstrument at the second time, and determining the change in theconfiguration of the medical instrument based on the configuration ofthe medical instrument at the first time and the configuration of themedical instrument at the second time.

In some embodiments, the method 410 is performed by a medical systemthat includes an input device (e.g., the input system 182) forcontrolling (e.g., movement, function) operation (e.g., teleoperation)of a robotic arm. The input device includes a grasper (e.g., the grasper200) that includes a first finger pad. The first finger pad includes afirst set of two or more electrodes. The medical system also includes anintegrated circuit (e.g., the integrated circuit 328) for measuring amutual capacitance between the two or more electrodes of the first setof two or more electrodes for determining a user presence at the firstfinger pad (e.g., user proximity to the first finger pad, or usercontact with the first finger pad).

FIG. 41 is a flowchart illustrating a method 420 of operating a medicalsystem that includes the input device of FIG. 21 .

The method 420 includes (4210) receiving, from a sensor coupled to(e.g., embedded in) a grasper of the input device, sensor informationrelated to a user presence at the grasper; (4220) receiving secondaryinformation from the input device; (e.g., a configuration of thegrasper, such as grasper angle or velocity, and/or a time point of lastgrasper movement or last-detected user presence); (4230) determiningwhether a user is in control of the input device based on the sensorinformation and the secondary information (e.g., although a capacitancesensor can detect lack of user presence, this alone is not sufficient totransition into a safe mode - instead, transition to the safe mode maynot be triggered until a certain amount of time has passed or a certaindrift distance has been detected. This helps reducing disruptions bycutting off teleoperation. If neither of these criteria is met, then thesystem can enter a “modified teleoperation” mode by, for example,changing motion scaling of the teleoperation, damping the input device,etc.); and (4240) in accordance with a determination that the user isnot in control of the input device, transitioning the medical systeminto a safe mode.

In some embodiments, the robotic arm is coupled to a medical instrumentcomprising a tool tip. Prior to transitioning the medical system intothe safe mode, the medical system operates (4202) in a modifiedteleoperation mode whereby motion scaling between the input device andthe medical instrument is changed such that movement of the tool tip inresponse to movement of the grasper is reduced. Such modifiedteleoperation mode allows a user to stay in uninterrupted teleoperation,but reduces likelihood of the user losing control when the user istransiently not in contact with the grasper (or the capacitancesensors).

In some embodiments, prior to transitioning the medical system into thesafe mode, the damping of the robotic arm is adjusted (4204) in responseto information from the input device.

In some embodiments, prior to transitioning the medical system into thesafe mode, haptic feedback is provided (4206) to a user (e.g., via thegrasper) to maintain a position of the input device.

In some embodiments, transitioning the medical system into the safe modeincludes (4242) halting operation of the robotic arm in response toinformation from the input device.

In some embodiments, the method 420 also includes transitioning themedical system into an (unmodified) teleoperation mode in accordancewith a determination that the user is in control of the input device.

In some embodiments, the method 420 further includes (4250)transitioning the medical system out of the safe mode (e.g.,transitioning the medical system into the (unmodified) teleoperationmode or the modified teleoperation mode) based on the sensor informationand the secondary information. The second information includesinformation indicating a duration of time the medical system has been inthe safe mode. For example, the medical system may wait for a certainperiod of time after user presence has been detected (e.g., using acapacitance sensor) before moving a robotic joint in accordance withuser input. This reduces or eliminates movement of a robotic joint dueto an inadvertent contact.

In some embodiments, the method 420 further includes transitioning themedical system out of the modified teleoperation mode (e.g.,transitioning the medical system into the (unmodified) teleoperationmode) based on the sensor information and the secondary information. Thesecond information includes information indicating a duration of timethe medical system has been in the safe mode.

In some embodiments, the method 420 further includes, (4260) when themedical system has been in the safe mode for a duration of time lessthan a predefined threshold, transitioning the medical system out of thesafe mode (e.g., transitioning the medical system into the (unmodified)teleoperation mode or the modified teleoperation mode) based on firstcriteria; and when the medical system has been in the safe mode for aduration of time longer than the predefined threshold, transitioning themedical system out of the safe mode (e.g., transitioning the medicalsystem into the (unmodified) teleoperation mode or the modifiedteleoperation mode) based on second criteria distinct from the firstcriteria. For example, the medical system may transition out of the safemode in response to detecting user presence on one sensor if the medicalsystem has been in the safe mode for a duration of time less than thepredefined threshold (e.g., one second), but may require detecting theuser presence on two or more sensors if the medical system has been inthe safe mode for a duration of time greater than the predefinedthreshold, before transitioning out of the safe mode.

In some embodiments, the method 420 further includes, when the medicalsystem has been in the modified teleoperation mode for a duration oftime less than a predefined threshold, transitioning the medical systemout of the modified teleoperation mode (e.g., transitioning the medicalsystem into the (unmodified) teleoperation mode) based on thirdcriteria; and when the medical system has been in the modifiedteleoperation mode for a duration of time longer than the predefinedthreshold, transitioning the medical system out of the modifiedteleoperation mode (e.g., transitioning the medical system into the(unmodified) teleoperation mode) based on fourth criteria distinct fromthe third criteria.

In some embodiments, the method 420 is performed by a medical systemthat includes an input device (e.g., the input system 183) forcontrolling a medical instrument (e.g., surgical tool). The input deviceincludes a grasper (e.g., the grasper 200) for receiving user input; anda sensor (e.g., one or more capacitance sensors) coupled to the grasperfor generating sensor information related to a user presence at thegrasper. The medical system also includes a processor (e.g.,processor(s) 280) and memory (e.g., computer readable storage medium282) storing instructions for execution by the processor. The storedinstructions include instructions for receiving secondary informationassociated with the grasper (e.g., a configuration of the grasper, suchas grasper angle or velocity, and/or a time point of last graspermovement or last-detected user presence) and determining user control atthe grasper based on the sensor information and the secondaryinformation.

In some embodiments, the sensor comprises any of a capacitance-basedsensor or a light-based sensor.

In some embodiments, the grasper includes a finger pad forming a grasperangle with respect to a reference axis of the grasper, the finger padbeing moveable relative to the reference axis. The secondary informationincludes the grasper angle.

In some embodiments, the input device includes a joint. The secondaryinformation includes a position and/or velocity of the joint.

In some embodiments, the joint comprises a passively stationary joint ofthe input device.

In some embodiments, the joint comprises a roll joint of the inputdevice.

In some embodiments, the secondary information includes a time thresholdfor comparison with a duration over which the sensor detects a lack of auser presence.

In some embodiments, the memory also stores instructions for determiningthe user presence based in part on a comparison of a duration over whichthe sensor does not detect the user presence and a time threshold.

In some embodiments, the secondary information includes informationindicating a change in a configuration (e.g., position and/ororientation) of the input device at a first time and a second time thatis subsequent to the first time (e.g., current time).

In some embodiments, the memory also stores instructions for determiningthe user presence based in part on a comparison of the configuration ofthe input device at the first time and a configuration of the inputdevice at the second time. In some embodiments, the first timecorresponds to a time point when the user presence was detected.

In some embodiments, the secondary information includes informationindicating a change in a configuration (e.g., position and/ororientation) of the medical instrument at a first time and a second timethat is subsequent to the first time (e.g., current time).

In some embodiments, the memory also stores instructions for determiningthe user presence based in part on a comparison of the configuration ofthe medical instrument at the first time and a configuration of themedical instrument at the second time. In some embodiments, the firsttime corresponds to a time point when the user presence was detected.

3. Implementing Systems and Terminology

FIG. 42 is a schematic diagram illustrating electronic components of amedical system that includes the input device of FIG. 21A.

The robotic medical system includes one or more processors 280, whichare in communication with a computer readable storage medium 282 (e.g.,computer memory devices, such as random-access memory, read-only memory,static random-access memory, and nonvolatile memory, and other storagedevices, such as a hard drive, an optical disk, a magnetic taperecording, or any combination thereof) storing instructions forperforming any methods described herein (e.g., operations described withrespect to FIGS. 33, 39A-39B, 40, and 41 ). The one or more processors280 are also in communication with an input/output controller 284 (via asystem bus or any suitable electrical circuit). The input/outputcontroller 284 receives user input from input device 286 (e.g., theinput system 182, or in particular, the grasper 200) and sensor datafrom one or more sensors (e.g., sensors 287, such as capacitancesensors, optical sensors, grasper angle sensor, etc. as describedherein, which are coupled to the input device 286), and relays thesensor data to the one or more processors 280. In some embodiments, thesensors 287 include the integrated circuit 328. In some embodiments, theintegrated circuit 328 is integrated with the one or more processors 280(or vice versa). The input/output controller 284 also receivesinstructions and/or data from the one or more processors 280 and relaysthe instructions and/or data to one or more actuators, such as firstmotors 292-1 and 292-2, etc. In some embodiments, the input/outputcontroller 284 is coupled to one or more actuator controllers 290 andprovides instructions and/or data to at least a subset of the one ormore actuator controllers 290, which, in turn, provide control signalsto selected actuators 292. In some embodiments, the one or more actuatorcontroller 290 are integrated with the input/output controller 284 andthe input/output controller 284 provides control signals directly to theone or more actuators 292 (without a separate actuator controller).Although FIG. 39 shows that there is one actuator controller 290 (e.g.,one actuator controller for the entire medical platform, in someembodiments, additional actuator controllers may be used (e.g., oneactuator controller for each actuator, etc.).

It should be noted that the terms “couple,” “coupling,” “coupled” orother variations of the word couple as used herein may indicate eitheran indirect connection or a direct connection. For example, if a firstcomponent is “coupled” to a second component, the first component may beeither indirectly connected to the second component via anothercomponent or directly connected to the second component.

The term “computer-readable medium” refers to any aval table medium thatcan be accessed by a computer or processor. By way of example, and notlimitation, such a medium may comprise random access memory (RAM),read-only memory (ROM), electrically erasable programmable read-onlymemory (EEPROM), flash memory, compact disc read-only memory (CD-ROM) orother optical disk storage, magnetic disk storage or other magneticstorage devices, or any other medium that can be used to store desiredprogram code in the form of instructions or data structures and that canbe accessed by a computer. It should be noted that a computer-readablemedium may be tangible and non-transitory. As used herein, the term“code” may refer to software, instructions, code or data that is/areexecutable by a computing device or processor.

The methods disclosed herein comprise one or more steps or actions forachieving the described method. The method steps and/or actions may beinterchanged with one another without departing from the scope of theclaims. In other words, unless a specific order of steps or actions isrequired for proper operation of the method that is being described, theorder and/or use of specific steps and/or actions may be modifiedwithout departing from the scope of the claims.

As used herein, the term “plurality” denotes two or more. For example, aplurality of components indicates two or more components. The term“determining” encompasses a wide variety of actions and, therefore,“determining” can include calculating, computing, processing, deriving,investigating, looking up (e.g., looking up in a table, a database oranother data structure), ascertaining and the like. Also, “determining”can include receiving (e.g., receiving information), accessing (e.g.,accessing data in a memory) and the like. Also, “determining” caninclude resolving, selecting, choosing, establishing and the like.

The phrase “based on” does not mean “based only on,” unless expresslyspecified otherwise. In other words, the phrase “based on” describesboth “based only on” and “based at least on.”

The previous description of the disclosed implementations is provided toenable any person skilled in the art to make or use the presentinvention. Various modifications to these implementations will bereadily apparent to those skilled in the art, and the generic principlesdefined herein may be applied to other implementations without departingfrom the scope of the invention. For example, it will be appreciatedthat one of ordinary skill in the art will be able to employ a numbercorresponding alternative and equivalent structural details, such asequivalent ways of fastening, mounting, coupling, or engaging toolcomponents, equivalent mechanisms for producing particular actuationmotions, and equivalent mechanisms for delivering electrical energy.Thus, the present invention is not intended to be limited to theimplementations shown herein but is to be accorded the widest scopeconsistent with the principles and novel features disclosed herein.

1. A medical system comprising: an input device for controllingoperation of a robotic arm, the input device comprising a graspercomprising a first finger pad, wherein the first finger pad comprises afirst set of two or more electrodes for determining a user presence atthe first finger pad; and a processor for modifying operation of therobotic arm in response to information from the input device inaccordance with a determination of the user presence at the first fingerpad.
 2. The medical system of claim 1, wherein the two or moreelectrodes include a first electrode and a second electrode that isinterdigitated with the first electrode.
 3. The medical system of claim1, wherein the two or more electrodes include a first electrode and asecond electrode that is disposed adjacent to the first electrode. 4.The medical system of claim 1, wherein: the grasper comprises a secondfinger pad distinct and separate from the first finger pad; the secondfinger pad includes a second set of two or more electrodes fordetermining a user presence at the second finger pad; and the userpresence at the second finger pad is determined independently of theuser presence at the first finger pad.
 5. The medical system of claim 4,wherein the grasper further comprises a third finger pad and a fourthfinger pad.
 6. The medical system of claim 5, wherein: the third fingerpad includes a third set of two or more electrodes for determining auser presence at the third finger pad; the fourth finger pad includes afourth set of two or more electrodes for determining a user presence atthe fourth finger pad; and the user presence at the first finger pad,the user presence at the second finger pad, the user presence at thethird finger pad, and the user presence at the fourth finger pad aredetermined independently of each other.
 7. The medical system of claim1, wherein in accordance with a determination of a lack of the userpresence, the processor ceases operation of the robotic arm in responseto the information from the input device.
 8. The medical system of claim1, wherein in accordance with a determination of a lack of the userpresence, the processor reduces a velocity of the robotic arm inresponse to the information from the input device.
 9. The medical systemof claim 1, wherein in accordance with a determination of a lack of theuser presence, the processor reduces motion scaling between the inputdevice and the robotic arm.
 10. The medical system of claim 1, wherein:the grasper further comprises an integrated circuit for measuring amutual capacitance between the two or more electrodes of the first setof two or more electrodes; and the user presence is determined based atleast in part on the mutual capacitance.
 11. The medical system of claim10, wherein: the grasper includes a static handle that is coupled to thefirst finger pad, the first finger pad configured to move relative tothe static handle; and the integrated circuit is disposed in the statichandle.
 12. The medical system of claim 1, wherein the first set of twoor more electrodes is embedded within the first finger pad.
 13. Themedical system of claim 1, wherein the first set of two or moreelectrodes comprises: an electrode layer comprising the two or moreelectrodes; and a shield layer for reducing capacitance between the twoor more electrodes with components of the grasper.
 14. A method foroperating a surgical tool via an input device, the method comprising, atone or more processors executing instructions stored in memory: whileoperating a robotic arm in response to information from an input device:receiving first information from a first set of two or more electrodes;determining a user presence at a first finger pad based on the firstinformation, the first finger pad comprising the first set of two ormore electrodes; and modifying operation of the robotic arm in responseto the information from the input device in accordance with adetermination of the user presence at the first finger pad.
 15. Themethod of claim 14, wherein: modifying teleoperation of the robotic armincludes at least one of: ceasing movement of the robotic arm inresponse to the information from the input device; reducing a velocityof the robotic arm in response to the information from the input device;or reducing motion scaling between the input device and the robotic arm.16. (canceled)
 17. (canceled)
 18. The method of claim 14, furthercomprising: determining, by an integrated circuit, a mutual capacitancebetween the two or more electrodes of the first set of two or moreelectrodes, wherein the user presence is determined based at least inpart on the mutual capacitance.
 19. The method of claim 14, furthercomprising: receiving second information from a second set of two ormore electrodes; determining a user presence at a second finger padbased on the second information, the second finger pad comprising thesecond set of two or more electrodes; and determining a user presence atthe second finger pad based at least in part on the second information.20. The method of claim 19, further comprising: modifying the operationof the robotic arm in response to the information from the input devicein accordance with a determination of the user presence at the secondfinger pad.
 21. The method of claim 19, further comprising: receivingthird information from a third set of two or more electrodes;determining a user presence at a third finger pad based at least in parton the third information, the third finger pad comprising the third setof two or more electrodes; receiving fourth information from a fourthset of two or more electrodes; and determining a user presence at afourth finger pad based at least in part on the fourth information, thefourth finger pad comprising the fourth set of two or more electrodes.22. A medical system comprising: an input device for controllingoperation of a robotic arm, the input device comprising: a graspercomprising a first finger pad, the first finger pad comprising a firstset of two or more electrodes; and an integrated circuit for measuring amutual capacitance between the two or more electrodes of the first setof two or more electrodes for determining a user presence at the firstfinger pad.